LETTERS TO THE EDITOR

 

A post-endoscopic retrograde cholangiopancreatography subcapsular hepatic hematoma

Hematoma subcapsular hepático post-colangiopancreatografía retrógrada endoscópica

 

 

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Key words: Hematoma. ERCP. Complication.

Palabras clave: Hematoma. CPRE. Complicación.

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Dear Editor,

With regard to the case published by Del Moral Martínez et al. (1), we would like to report a recent clinical case in our center. Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive technique with a low complication rate. A subsequent hepatic hematoma is an exceptional occurrence (1-3).

 

Case Report

Recently, a 43-year-old cholecystectomized patient underwent an ERCP due to choledocholithiasis. Some hours after the procedure, the patient experienced abdominal pain in the right upper quadrant and anemia. An abdominal computed tomography (CT) showed a subcapsular hepatic hematoma of 16 x 7 x 16 cm that compressed and displaced the hepatic parenchyma towards the midline (Fig. 1). Angio-TC was subsequently performed without contrast extravasation.

 

 

Due to the clinical stability and the absence of active bleeding, the patient was managed conservatively and monitored in the Intensive Care Unit (ICU), where she remained hemodynamically stable. After ten days, a control CT identified a persistent collection. A percutaneous drainage was consequently performed and 1,000 ml of blood content were extracted. The evolution was favorable and the patient was discharged 12 days later. However, she required a repeat drainage a few days later and about 1,100 ml were extracted. Subsequently, she was asymptomatic.

 

Discussion

Post-ERCP hepatic subcapsular hematoma is a rare complication (3,4). The etiology is not clear, although it can originate from the damage of intrahepatic vessels by a metallic guide. The management is usually conservative, with a good evolution (5).

 

Rocío Soler-Humanes, Miguel Ángel Suárez-Muñoz and Blanca García-García
Department of Digestive and General Surgery.
Hospital Universitario Virgen de la Victoria. Málaga, Spain

 

References

1. Del Moral Martínez M, Delgado Maroto A, Cervilla Sáez de Tejada ME, et al. Hepatic hematoma after ERCP: Two new case reports. Rev Esp Enferm Dig 2017;109(6):470-3. DOI: 10.17235/reed.2017.4237/2016.         [ Links ]

2. Servide MJ, Prieto M, Marquina T. Hepatic subcapsular hematoma: A rare late complication after ERCP. Rev Esp Enferm Dig 2016; 108(4):234-5.         [ Links ]

3. González-López R, García Cano E, Espinosa González O, et al. Tratamiento quirúrgico para hematoma subcapsular hepático posterior a colangiografía retrógrada endoscópica; caso inusual. Cir Cir 2015;83(6):506-9. DOI: 10.1016/j.circir.2015.05.028.         [ Links ]

4. Fei BY, Li CH. Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancrea-tography: An unusual case. World J Gastroenterol 2013;19(9):1502-4. DOI: 10.3748/wjg.v19.i9.1502.         [ Links ]

5. Zizzo M, Lanaia A, Barbieri I, et al. Hepatic hematoma after endoscopic retrograde cholangiopancreatography. A case report and review of literature. Medicine 2015;94(26):1041. DOI: 10.1097/MD.0000000000001041.         [ Links ]