S1462 Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography (ERCP)

Abstract

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures for the treatment of pancreatico-biliary diseases. ERCP-related complications total around 2.5% to 8%, with a mortality rate ranging from 0.5% to 1%. An exceptionally rare ERCP complication is subcapsular hepatic hematoma, and few cases are reported worldwide. We report two cases of subcapsular hepatic hematoma secondary to spybites. CASE DESCRIPTION/METHODS: Patient 1 was a 74 year old female with mid common bile duct stricture who underwent ERCP with cholangioscopy with spybites and stent placement. Patient 2 was 43 year old male with hilar stricture s/p ERCP with cholangioscopy with spybites and stent placement. Post ERCP, both patients developed worsening abdominal pain and elevated liver function tests, however had normal lipase levels. A CT scan of the abdomen showed large subcapsular hematoma. Both patients were managed conservatively and neither required embolization. DISCUSSION: Although, case reports have reported subcapsular hematoma after ERCP due to wire trauma to intrahepatic vessels, we report the first case of subcaspular hematoma following spybites. 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/laboratory data as well as imaging (ultrasound, CT, or MRI). Treatment is often conservative but, in some cases, embolization or percutaneous drainage or surgery may be necessary.Figure 1.: Subcapsular hepatic hematoma.