Rogelio González-López1, Eugenio García-Cano2, Omar Espinosa-González3, Ángel Cruz-Salgado2, Álvaro-José Montiel-Jarquin4, Valeria Hernández-Zamora5. 1. Servicio Cirugía General, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Puebla, Puebla, México. Electronic address: drrgonzalezl@hotmail.com. 2. Servicio Cirugía General, Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social, Puebla, Puebla, México. 3. Servicio Cirugía General, Hospital General de Zona Número 17, Instituto Mexicano del Seguro Social, Texcoco, Estado de México, México. 4. Jefatura de Investigación, Unidad Médica de Alta Especialidad, Hospital de Trauma y Ortopedia, Puebla, Puebla, México. 5. Universidad Popular Autónoma del Estado de Puebla, Heroica Puebla de Zaragoza, Puebla, México.
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.
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.
Authors: C Sommariva; A Lauro; N Pagano; S Vaccari; V D'Andrea; I R Marino; M Cervellera; V Tonini Journal: Dig Dis Sci Date: 2019-08 Impact factor: 3.199
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