Abstract
A 78-year-old woman with hilar cholangiocarcinoma and pre-existing plastic biliary stents presented with septic shock secondary to cholangitis. Abdominal CT revealed a large, subcapsular, air-filled cavity in the right hepatic lobe extending from the tip of the right hepatic stent, with only a thin rim of capsule at the superior aspect (A, arrows). After resuscitation with fluids, antibiotics, and vasopressors, emergent ERCP was performed. On introduction of the duodenoscope and before biliary cannulation (B, arrows), spontaneous rupture of the subcapsular cavity was identified on fluoroscopy, with perihepatic and subdiaphragmatic pneumoperitoneum (B, C, arrows, D).
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