Subcapsular hematoma due to endoscopic retrograde cholangiopancreatography is a rare complication. There are only a few case reports in this subject in literature. This report's aim is to present subcapsular hematoma due to endoscopic retrograde cholangiopancreatography case and compare it with the literature. A sixty-nine-year-old female patient was admitted to the clinic with abdominal pain and jaundice. In physical examination epigastric tenderness was present. Patient went under ERCP procedure due to choledocholithiasis. 1.5 cm of filling defect was seen in hilar region i n ERCP. The gallstone was extracted with endoscopic sphincterotomy, balloon and basket. 12 hours after being discharged, patient admitted to the emergency service presenting low blood pressure, fatigue and abdominal pain. Arterial blood pressure and heart rate was respectively 90/60 mmHg and 100 bpm. Abdominal examination presented tenderness, guarding and rebound in all quadrants. Ultrasonography and general abdominal computed tomography showed subcapsular liver hematoma and subdiaphragmatic free air. The patient was operated due to acute abdomen. During exploration, laceration and subcapsular hematoma was present on the anterior face of the right lobe. Lacerated area was sutured simply. Postoperative day 9 patient was discharged with no complications. Patient was admitted presenting fever and abdominal pain postoperative month 1. USG and CT revealed that an approximately 10x3 cm heterogenic collection adjacent to the left lobe of the liver was reaching out to epigastrium. Percutaneous drainage was performed. Drainage was continued for 1 week. Control USG revealed regression and drainage was terminated. No complications were observed in patients 1 year of follow-up. Subcapsular hematoma of the liver is a rare complication. It should be considered in case of sudden hypotension and abdominal pain after ERCP. Conservative treatment should be considered in the foreground, however, surgery should be scheduled in case of acute abdomen and/or hemodynamic instability
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Liao Z, Hu LH, Li ZS, Zuo CJ, Wang L, Jin G, Zou DW, Jin ZD, Li SD, Liu F, Chen J, Zhan XB, Yuan JH, Wang LW, Wang D. Multidisciplinary team meeting before therapeutic ERCP: A prospective study with 1,909 cases. J Interv Gastroenterol. 2011;1(2):64-9.
Sutton VR, Hong MK, Thomas PR.Thomas. Using the 4-hour Post-ERCP Amylase Level to Predict Post-ERCP Pancreatitis. JOP. J Pancreas. 2011;12(4):372-6.
Hart R, Classen M. Complications of diagnostic gastrointestinal
endoscopy. Endoscopy. 1990;22:229-33.
Ortega Deballon P, Fernández Lobato R, García Septiem J, Nieves Vázquez MA, Martínez Santos C, Moreno Azcoita M.. Liver hematoma cholangiopancreatography (ERCP). Surg Endosc. 2000;14(8):767. endoscopio retrograde
Ruiz-Tovar J, Lobo E, Sanjuanbenito A, Martínez-Molina E. Pneumoretroperitoneum secondary to duodenal perforation secondary to endoscopic retrograde cholangiopancreatography. Can J Surg. 2009;52(1):68-9.
Lynch SP, Evans JA. Difficult biliary cannulation. Curr Gastroenterol Rep. 2010;12(2):135-40.
Priego P, Rodríguez G, Mena A Losa N, Aguilera A, Ramiro C, Lisa E, Conde S, Fresneda V. Hematoma sub-capsular hepático tras CPRE. Rev Esp Enf Ap Dig. 2007;99(1):53-4.
Nari GA, Preciado Vargas J, Rosendo Ballesteros N. A rare complication of ERCP: sub-capsular liver haematoma. Cir Esp. 2009;85(4):253-63.
Priego P, Rodríguez G, Mena A, Losa N, Aguilera A, Ramiro C, Lisa E, Conde S, Fresneda V. Hematoma hepático post ERCP. Rev Esp Enferm Dig. 2007;99(1):53-4.