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Kim S, So H, Jung SW, Bang SJ. Guidewire Impaction in the Main Pancreatic Duct in a Patient with Chronic Pancreatitis: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:36-39. [PMID: 36695065 DOI: 10.4166/kjg.2022.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023]
Abstract
The guidewire is an essential accessory in ERCP. Although rare, guidewires can cause complications, such as subcapsular hepatic hematoma, perforation, knotting, fracture, and impaction, during ERCP. This report describes a guidewire impaction during the endoscopic treatment of a patient with symptomatic chronic pancreatitis. The methods used to treat guidewire impaction are not well known. In the present case, the impacted guidewire was retrieved by inserting another guidewire and dilating the space adjacent to it. Endoscopists should check for the free movement of the guidewire before stent deployment. Additionally, it is important to ask for help from experienced senior staff to overcome any challenges during the procedure. In conclusion, endoscopists should be aware of the possibility of a guidewire impaction during ERCP.
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Affiliation(s)
- Soyoung Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hoonsub So
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seok Won Jung
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Jo Bang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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2
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Intraparenchymal hepatic hematoma following endoscopic retrograde cholangiopancreatography: Risk factors and conservative approach in acute management. Hepatobiliary Pancreat Dis Int 2021; 20:293-295. [PMID: 32988762 DOI: 10.1016/j.hbpd.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/31/2020] [Indexed: 02/05/2023]
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3
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Pivetta LGA, da Costa Ferreira CP, de Carvalho JPV, Konichi RYL, Kawamoto VKF, Assef JC, Ribeiro MA. Hepatic subcapsular hematoma post-ERCP: Case report and literature review. Int J Surg Case Rep 2020; 72:219-228. [PMID: 32544833 PMCID: PMC7298556 DOI: 10.1016/j.ijscr.2020.05.074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed minimally invasive procedures currently available for diagnosis and treatment of biliary and pancreatic diseases. Though considered a safe procedure, it has the highest rate of complications among the other endoscopic procedures, such as duodenal perforation and hepatic subcapsular hematoma (HSH). We are a presenting a case report and review of the current literature. METHOD We report one case HSH rupture, in a 25 years old female patient, 15 cm in diameter, affecting liver segments VI, VII and VIII, who underwent surgical treatment and performed a systematic literature review with the descriptors: endoscopic retrograde colangiopancreatography and hepatic subcapsular hematoma. All articles were reviewed and data on cases that presented rupture of the HSH analyzed separately. RESULTS Sixty one cases of HSH were described in the literature, fourteen of them ruptured. When analyzing only the subgroup of patients who had ruptured subcapsular hematoma, we showed a significant increase in the mortality rate of patients when compared to non-ruptured (21.4% × 2.2%). We also report that patients with rupture required some type of intervention, of which 78.6% required surgery. Conservative treatment may be the conduct and will suffice for most cases of non-ruptured hematomas. For patients who evolve with rupturing, surgical resolution, although non-mandatory, is necessary in most cases. CONCLUSION HSH ruptured is a rare and potentially fatal post-ERCP complication whose treatment is eminently surgical.
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Affiliation(s)
| | | | | | | | | | - Jose Cesar Assef
- Emergency Service of the Irmandade da Santa Casa de São Paulo (ISCMSP), São Paulo, SP, Brazil
| | - Mauricio Alves Ribeiro
- Emergency Service of the Irmandade da Santa Casa de São Paulo (ISCMSP), São Paulo, SP, Brazil
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Sommariva C, Lauro A, Pagano N, Vaccari S, D'Andrea V, Marino IR, Cervellera M, Tonini V. Subcapsular Hepatic Hematoma Post-ERCP: Case Report and Review of the Literature. Dig Dis Sci 2019; 64:2114-2119. [PMID: 31197631 DOI: 10.1007/s10620-019-05679-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hepatic hematoma is a rare but possible complication of ERCP. We describe the case of a 75-year old man with a large, 8 × 12 cm, sub-capsular and intra-parenchymal hematoma post ERCP, affecting the right liver segments and treated conservatively. AREAS COVERED A review of literature has been performed, highlighting two possible mechanisms: hematoma may occur as the result of accidental laceration of a small intrahepatic vessel by the guidewire, whereas the other hypothesis posits that the hepatic damage is secondary to traction on the biliary system exerted by the balloon. We speculate that in case of anomalies of the biliary tree, the incidence of this complication is higher than expected. EXPERT COMMENTARY In case of hepatic hematoma post ERCP, a conservative approach should always be considered before proceeding to interventional radiologic procedures or to surgical therapy.
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Affiliation(s)
- C Sommariva
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy.
| | - N Pagano
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
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Imperatore N, Micheletto G, Manes G, Redaelli DG, Reitano E, de Nucci G. Systematic review: Features, diagnosis, management and prognosis of hepatic hematoma, a rare complication of ERCP. Dig Liver Dis 2018; 50:997-1003. [PMID: 30097261 DOI: 10.1016/j.dld.2018.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatic hematoma (HH) is a rare but severe adverse event following endoscopic retrograde cholangiopancreatography (ERCP). AIMS To perform a systematic literature review and describe two additional cases, one of which presenting multiple subcapsular/intrahepatic hematomas after ERCP. METHODS The literature review was performed in PubMed/MEDLINE, EMBASE, and SCOPUS to identify all cases reporting on HH after ERCP. RESULTS A total of 48 cases (females 63%, mean age 58.2 ± 20.6 years) were included. The mean symptoms onset time was 46.8 h after ERCP, and the most common symptoms were abdominal pain (91.7%), anaemia (43.8%), hypotension (29.2%) and fever (20.8%). All cases were diagnosed by computed tomography (CT). HH was found mostly in the right hepatic lobe (95.1%) and the mean size was 116 × 93 mm. A conservative management was adopted in 38.3% of cases, while percutaneous drainage, embolization and surgery were needed in 31.9%, 14.9% and 25%. Mortality rate was about 9%. Anaemia (OR 6.9; p = 0.02) and surgery (OR 10.5; p < 0.01) were the only independent factors for unfavorable outcome (death), while abdominal pain (OR 0.1; p = 0.03) and antibiotics administration (OR 0.06; p < 0.001) were associated with better outcome. CONCLUSIONS HH is a rare but severe complication following ERCP which needs a multidisciplinary approach. Antibiotics administration is the only treatment able to reduce the risk of death.
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Affiliation(s)
- Nicola Imperatore
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy; Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy.
| | - Giancarlo Micheletto
- Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy; Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Gianpiero Manes
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy
| | | | - Elisa Reitano
- Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Germana de Nucci
- Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy
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6
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Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography. A rare complication with high morbidity and mortality. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:23-27. [PMID: 29502888 DOI: 10.1016/j.gastrohep.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 02/03/2023]
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7
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A.M. A, A.A. A, M.F. A, S.A. A. Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2017-71-cr-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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8
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Zappa MA, Aiolfi A, Antonini I, Musolino CD, Porta A. Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review. World J Gastroenterol 2016; 22:4411-4415. [PMID: 27158211 PMCID: PMC4853700 DOI: 10.3748/wjg.v22.i17.4411] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 02/06/2023] Open
Abstract
Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic.
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9
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Papillary adenoma of the common bile duct: infrequent pathology, novel endoscopic resolution, rare complication. A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Curvale C, Guidi M, Málaga I, Hwang HJ, Matanó R. Papillary adenoma of the common bile duct: Infrequent pathology, novel endoscopic resolution, rare complication. A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 81:109-11. [PMID: 26993161 DOI: 10.1016/j.rgmx.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/01/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- C Curvale
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red «El Cruce»-Néstor Carlos Kirchner, Buenos Aires, República Argentina.
| | - M Guidi
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red «El Cruce»-Néstor Carlos Kirchner, Buenos Aires, República Argentina
| | - I Málaga
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red «El Cruce»-Néstor Carlos Kirchner, Buenos Aires, República Argentina
| | - H J Hwang
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red «El Cruce»-Néstor Carlos Kirchner, Buenos Aires, República Argentina
| | - R Matanó
- Servicio de Gastroenterología, Hospital de Alta Complejidad en Red «El Cruce»-Néstor Carlos Kirchner, Buenos Aires, República Argentina
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11
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Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury. Case Rep Surg 2015; 2015:670323. [PMID: 26693377 PMCID: PMC4674614 DOI: 10.1155/2015/670323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/12/2015] [Indexed: 01/30/2023] Open
Abstract
ERCP is attended with certain complications, the majority of which are well known to the medical community. Other less-known complications also exist. Guidewire injury to the hepatic or pancreatic parenchyma represents one of the much less appreciated, albeit preventable, complications. In this report, we present the clinical course of three patients who sustained guidewire perforation of the pancreatic or hepatic parenchyma. In one patient, the clinical deterioration was confidently attributed to guidewire perforation of the pancreatic parenchyma. Conservative treatment was successful and unnecessary emergency surgery was thus avoided. In the other two, in whom the cause of the clinical deterioration was unclear, an emergency surgery was performed. Guidewire injury to the hepatic parenchyma was then confirmed which needed only intraperitoneal drainage, with successful outcome.
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12
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González-López R, García-Cano E, Espinosa-González O, Cruz-Salgado Á, Montiel-Jarquin ÁJ, Hernández-Zamora V. [Surgical treatment for liver haematoma following endoscopic retrograde cholangiopancreatography; An unusual case]. CIR CIR 2015; 83:506-9. [PMID: 26319688 DOI: 10.1016/j.circir.2015.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Even in expert hands, there can be serious complications when performing an endoscopic retrograde cholangiopancreatography. The most frequent complications are pancreatitis, cholangitis, bleeding, perforation, and acute cholecystitis. The hepatic subcapsular haematoma is a rare complication, with few cases described worldwide. OBJECTIVE A case is presented of an extremely rare complication of endoscopic retrograde cholangiopancreatography, which required surgical treatment for its resolution without success. This is second case of mortality reported in the literature. CLINICAL CASE Female patient of 30 years old, with indication for endoscopic retrograde cholangiopancreatography due to benign strictures. A hydro-pneumatic dilation and stent placement of 2 gauge 10 fr was performed. She presented abdominal pain after the procedure and significant decline in haemoglobin with no evidence of haemodynamic instability so an abdominal tomography scan was performed, showing no evidence of liver injury. The patient was haemodynamic unstable within 72 h. A laparotomy was required for damage control, with fatal outcome in the intensive care unit due to multiple organ failure. CONCLUSION Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography is a rare complication, with few cases reported in the literature. Treatment described in the literature is conservative, resulting in a satisfactory resolution.
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Affiliation(s)
- Rogelio González-López
- Servicio Cirugía General, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Puebla, Puebla, México.
| | - Eugenio García-Cano
- Servicio Cirugía General, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - Omar Espinosa-González
- Servicio Cirugía General, Hospital General de Zona Número 17, Instituto Mexicano del Seguro Social, Texcoco, Estado de México, México
| | - Ángel Cruz-Salgado
- Servicio Cirugía General, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - Álvaro-José Montiel-Jarquin
- Jefatura de Investigación, Unidad Médica de Alta Especialidad, Hospital de Trauma y Ortopedia, Puebla, Puebla, México
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Zizzo M, Lanaia A, Barbieri I, Zaghi C, Bonilauri S. Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography: A Case Report and Review of Literature. Medicine (Baltimore) 2015; 94:e1041. [PMID: 26131812 PMCID: PMC4504646 DOI: 10.1097/md.0000000000001041] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the diagnosis and treatment of biliary-pancreatic diseases. ERCP-related complications total around 2.5% to 8%, with a mortality rate ranging from 0.5% to 1%. An exceptional ERCP complication is subcapsular hepatic hematoma, and few cases are reported worldwide.We present the case of a 52-year-old woman with a history of recurring upper abdominal pain and a clinical and ultrasonographic diagnosis of obstructive jaundice due to common bile duct stones. After 2 difficult endoscopic biliary procedures, common bile duct stones clearance was obtained. Post-ERCP course was symptomatic with upper abdominal pain and anemization with hemodynamic instability.CT scan demonstrated a 15 cm × 11 cm subcapsular hepatic hematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with the embolization of a small branch of right hepatic artery angiographically identified as the cause of bleeding.Subcapsular hepatic hematoma after ERCP is a rare complication that must be taken into account in the differential diagnosis of symptomatic cases after ERCP. Its diagnosis is based on clinical and laboratory data and especially on imaging (ultrasound, CT, or MRI). Treatment is often conservative but, in some cases, embolization or percutaneous drainage or surgery may be necessary.
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Affiliation(s)
- Maurizio Zizzo
- From the Department of General Surgery, C.S. General and Emergency Surgery, Azienda Ospedaliera - IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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Young Bang J, Coté GA. Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Klímová K, Suárez CP, Asanza CG, Peña AM, Arregui EC, Alonso AH. Subcapsular Hepatic Hematoma after ERCP: A Case Report and Revision of Literature. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/crcm.2014.33039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Fei BY, Li CH. Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancrea-tography: An unusual case. World J Gastroenterol 2013; 19:1502-1504. [PMID: 23538782 PMCID: PMC3602514 DOI: 10.3748/wjg.v19.i9.1502] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 12/16/2012] [Accepted: 01/19/2013] [Indexed: 02/06/2023] Open
Abstract
Subcapsular hepatic haematoma is a rare complication of endoscopic retrograde cholangiopancrea-tography (ERCP), and there are few reports about this unusual complication worldwide. The primary symptom of most cases reported in the literature is abdominal pain. We report an unusual case with the primary symptom of fever. A 56-year-old man who had a six-month history of recurrent episodes of upper abdominal pain was diagnosed with a common bile duct stone by magnetic resonance cholangiopancrea-tography. Endoscopic biliary sphincterotomy was performed, and stones from the common bile duct were successfully extracted with a basket. The patient had a persistent fever after ERCP, and treatment with intravenous antibiotics was unsuccessful. Computed tomography showed a 13 cm × 6 cm subcapsular hepatic haematoma filled with air and liquid on the surface of the right hepatic lobe. The patient was successfully treated with peritoneal drainage under B-ultra guidance. Subcapsular liver haematoma should be considered when hard-to- explain symptoms persist in the early period after ERCP. Percutaneous drainage is an effective treatment.
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Baudet JS, Arguiñarena X, Redondo I, Tadeo E, Navazo L, Mendiz J, Montiel R. [Subcapsular hepatic hematoma: an uncommon complication of endoscopic retrograde cholangiopancreatography]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:79-82. [PMID: 21354659 DOI: 10.1016/j.gastrohep.2010.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/01/2010] [Accepted: 11/02/2010] [Indexed: 12/29/2022]
Abstract
This report describes the case of a patient who developed a subcapsular hepatic hematoma 48 hours after endoscopic retrograde cholangiopancreatography. She was treated by embolizing the sites of bleeding and by surgically resecting the area. We review the literature and discuss the potential mechanisms that cause this complication.
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Affiliation(s)
- Juan-Salvador Baudet
- Unidad de Endoscopia Digestiva, HUNSC, Santa Cruz de Tenerife, Canarias, España.
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18
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Cárdenas A, Crespo G, Balderramo D, Bordas JP, Sendino O, Llach J. Subcapsular liver hematoma after Endoscopic Retrograde Cholangiopancreatography in a liver transplant recipient. Ann Hepatol 2008; 7:386-388. [PMID: 19034242 DOI: 10.1016/s1665-2681(19)31843-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Endoscopic Retrograde Cholangiopancreatography (ERCP) is commonly performed in patients after liver transplantation. The most common indications for ERCP include treatment of bile leaks and anastomotic and nonanastomotic biliary strictures. In this report we describe an unusual complication of ERCP in a liver transplant recipient with a bile leak two months after orthotopic liver transplantation (OLT). After confirming a bile leak, a hydrophilic guide wire was placed in the intrahepatic duct, an endoscopic sphincterotomy was performed, and a biliary plastic stent was successfully placed over the wire across the bile leak. Within the following 24 hours the patient developed a sharp right-sided upper quadrant pain and a drop in his hemoglobin level. An abdominal CT scan demonstrated a subcapsular hepatic hematoma that was successfully managed conservatively.
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Affiliation(s)
- Andrés Cárdenas
- GI/Endoscopy Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clínic and University of Barcelona, Barcelona, Spain.
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