Hepatic Subcapsular Hematoma: A Rare Complication After ERCP: A Case Report and Review of Literature

TL;DR

A rare complication of ERCP is subcapsular hepatic hematoma, which requires early detection and may need surgical intervention if it worsens or becomes infected.

Contribution

This case report adds to the limited literature on subcapsular hepatic hematoma following ERCP and emphasizes the need for prompt diagnosis and treatment.

Findings

A 32-year-old woman developed a large subcapsular hepatic hematoma after ERCP for gallstone pancreatitis.

Conservative management failed, and surgical intervention was required due to hematoma enlargement and infection.

Early clinical vigilance and imaging are crucial for detecting post-ERCP complications.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for diagnosing and treating biliary and pancreatic disorders, yet it carries a risk of complications, including the rare development of subcapsular hepatic hematoma (SHH). We report the case of a 32‐year‐old woman who presented with abdominal pain following ERCP for gallstone pancreatitis. She was afebrile and hemodynamically stable but appeared pale and exhibited right upper quadrant and epigastric tenderness. Laboratory evaluation revealed a hemoglobin drop to 8.6 g/dL. Computed tomography demonstrated a large right‐lobe subcapsular hepatic hematoma measuring 15.5 × 7.5 cm with associated air locules. Despite initial conservative management, the hematoma enlarged, and the patient subsequently underwent laparoscopic cholecystectomy with evacuation of the infected hematoma 3 days after admission. This case highlights the importance of early clinical vigilance and prompt imaging in the detection of post‐ERCP complications. Although conservative therapy may be effective in stable cases, surgical intervention becomes essential when complications progress or infection develops.

A rare but possibly fatal side effect of ERCP is subcapsular hepatic hemorrhage. Early detection by imaging and careful observation is essential for prompt identification. Even though conservative treatment is often successful, in order to minimize serious morbidity and improve patient outcomes, prompt surgical intervention is necessary in situations of infection or progression.

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