Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4411-4415
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4411
Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review
Marco Antonio Zappa, Alberto Aiolfi, Ilaria Antonini, Cinzia Domenica Musolino, Andrea Porta
Marco Antonio Zappa, Alberto Aiolfi, Ilaria Antonini, Cinzia Domenica Musolino, Andrea Porta, University of Milan, Department of General and Emergency surgery, Ospedale S Famiglia Fatabenefratelli, 22036 Erba, Italy
Author contributions: Zappa MA, Aiolfi A and Porta A contributed to study concept/design, data collection, data analysis, data interpretation, writing the paper; Antonini I and Musolino CD contributed to data collection.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University of Milan.
Informed consent statement: The patient involved in this study gave written informed consent authorizing use and disclosure of personal protected health information.
Conflict-of-interest statement: Marco Antonio Zappa, Alberto Aiolfi, Ilaria Antonini, Cinzia Domenica Musolino and Andrea Porta declare no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Marco Antonio Zappa, Professor, Department of General and Emergency surgery, Ospedale S Famiglia Fatabenefratelli, Via Fatebenefratelli, 20, 22036 Erba, Italy.
Telephone: +39-31-638359
Received: December 11, 2015
Peer-review started: December 11, 2015
First decision: January 13, 2016
Revised: January 26, 2016
Accepted: February 22, 2016
Article in press: February 22, 2016
Published online: May 7, 2016

Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic.

Keywords: Endoscopic guidewire, Endoscopic retrograde cholangiopancreatography, Abdominal pain, Subcapsular hepatic hematoma, Embolization

Core tip: Hepatic hematoma is a rare and potentially life threatening complication after endoscopic retrograde cholangiopancreatography (ERCP). Despite its severity, only few cases are described in current literature. The paper describe the management of a huge right lobe hepatic hematoma following ERCP. An exhaustive literature analysis is made considering, signs and symptoms at presentation, time of presentation, diagnosis, and treatment. Awareness of this potential complication, high level of suspicion and prompt treatment are at the basis of better outcomes in such patients.