Subcapsular left hepatic lobe hematoma: A potentially life-threatening post-ERCP complication

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is minimally invasive procedure commonly performed for biliary and pancreatic diseases. According to literature, the most common related complication are pancreatitis, post-sphincterotomy bleeding, perforation and cholangitis. This is rare and exceptional ERCP complication and only few cases have been reported. We report a case of rare post-ERCP complication, subcapsular liver hematoma that was diagnosed 16 hour post-ERCP in 28-year-old lady with intra-abdominal collection, ultrasound guided drainage of suspected bile leak was done, but the drained fluid was bloody (blood mixed with bile), with total amount of 900 ml in the first 36 hours. Patient received 2 units packed RBCs and she maintain her vital sign and hemoglobin 8.5 g/dl. Computed tomography scan of abdomen revealed a large left hepatic lobe subcapsular hematoma 16x7x12 cm with no active bleeding causing compression of the left hepatic vessels. On the basis of laboratory, clinical, and hemodynamic parameters the patient was hemodynamically stable. She was managed conservatively with only ultrasound guided drained of abdominal collection and no any radiological or surgical intervention needed for the hematoma.