Subcapsular hepatic hematoma as a complication associated with ERCP: presentation of a case in a geriatric patient

Abstract

Introduction: A 68-year-old female patient who began her condition with the presence of transfictive pain in the epigastrium, presenting pancreatitis diagnosed by tomographic, clinical and biochemical parameters, and later performing endoscopic retrograde cholangiopancreatography, subsequently with data compatible with hepatic sub capsular hematoma by tomography, in addition to presenting bilateral pleural effusion, the treatment of the hematoma was purely conservative. Radiological follow-up was performed during the following two weeks, evidencing progressive hemolysis of the hematoma. Discussion: Hepatic sub capsular hematoma is a rare complication of endoscopic retrograde cholangiopancreatography. The presentation of this type of complications is infrequent and little reported in literature, the exact mechanism by which it can occur is not yet known, however in several reports it is thought that the metallic guide produces accidental injury of a hepatic blood vessel and, consequently, produces a bleeding that accumulates under the hepatic capsule, producing pain in the right hypochondrium due to the distension of the same. In addition to the pain, the drop-in hemoglobin is a suspicion of this condition. In this case, the patient presented with hypovolemic shock, presenting prerenal kidney injury requiring renal replacement management, was managed with crystalloid solutions, blood transfusion, conservative management and serial tomographic controls. In addition to having a bilateral pleural effusion that did not merit interventionist management. The treatment of the hematoma reported by the majority of authors has been conservative with restitution of blood loss and volume, surgical treatment is reserved for cases with patient deterioration, hemodynamic instability and data of peritoneal irritation that can lead to a broken hepatic hematoma. Conclusion: The pathology of hepatic sub capsular hematoma is a rare complication of endoscopic retrograde cholangiopancreatography that its management will require supportive management and only merits surgical management if it ruptures.