Hepatic subcapsular hematoma: A rare complication post-ERCP; a case report

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in gastroenterology wards for both diagnostic and therapeutic purposes. It doesn’t however come free of complications. As a matter of fact, complications are reported in up to 10% of patients undergoing ERCP. Patient Concerns: In this article, we report the case of a patient who underwent ERCP and sphincterotomy for choledocholithiasis. Twenty-four hours after the procedure, the patient developed sudden sharp abdominal pain and dropped her hemoglobin levels. Diagnosis: An emergent gastroscopy was done and it ruled out bleeding from the sphincterotomy. Computed tomography of the abdomen showed a large hepatic subcapsular hematoma. Interventions: Blood was urgently transfused and the patient was transferred to the intensive care unit for monitoring. Outcomes: The patient’s condition quickly deteriorated despite extensive resuscitative measures, and eventually passed away on day 4 post ERCP. Lessons: Hepatic subcapsular hematoma is a very rare but fatal complication after ERCP and should be ruled out in patients who underwent the procedure and develop sudden abdominal pain with hemodynamic and laboratory instability.