Subcapsular Hepatic Hematoma Following Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure for indications of pancreatobiliary diseases. Hepatic hematoma is a very rare complication of this procedure. In this case report, we aimed to present subcapsular hepatic hematoma complication and review current literature. A 72-year-old woman was admitted with jaundice to our outpatient clinic. Her lab results were as follows: ALT 700 U/L (15-35), AST: 472 U/L (15-35), ALP: 355 U/L (40-120), T. Bilirubin: 5.5 mg/dl (0.3-1.2), D. Bil: 3.15 mg/dl (0-0.2), GGT: 212 U/L (0-38). Magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced magnetic resonance imaging (MRI) revealed a lesion involving the proximal common bile duct (CBD), possibly extending into both major hepatic bile ducts and causing narrowing of the lumen and contrast enhancement (Klatskin tumor'). Intrahepatic biliary tracts were dilated in both lobes, especially on the left. Due to the involvement of CBD, biliary plastic stenting was performed for malignant biliary obstruction (bismuth type 2) with ERCP. On the second day after ERCP, the patient complained of abdominal pain radiating to the back with no defence and rebound tenderness. Lab results were as follows; ALT: 342 U/L (15-35), AST: 329 U/L (15-35), ALP: 306 U/L (40-120), T. Bilirubin:10.2 mg/dl (0.3-1.2), D. Bil:6, 16 mg/dl (0-0,2), GGT:165 U/L (0-38). Computed tomography showed 45 mm of subcapsular hepatic hematoma with air and liquid on the surface of the right lobe of the liver. The patient was conservatively treated and followed up with antibiotherapy in surgery intensive care unit. She was not suitable for surgery and percutaneous drainage or vascular embolization. In conclusion, subcapsular hepatic hematoma is a rare complication of ERCP. Moreover, its mortality rate is low and it may occur in certain conditions. If abdominal pain, fever, anemia and hypotension develop in the patient, this complication should be considered after ERCP. It should be included in informed consent for the ones who will perform ERCP in endoscopy units.