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• W2911575549 abstract "Splenic hematoma is an extremely rare but known complication of endoscopic retrograde cholangiopancreatography (ERCP) with only 20 cases reported in the last 27 years. On the other hand, Acute pancreatitis is the most common with an incidence rate of 3-5%. Here we report a patient who underwent an ERCP that was unfortunately complicated by both splenic hematoma and acute pancreatitis. A 44-year-old female presented to the ED complaining of intractable nausea and vomiting associated with severe epigastric pain of a few days duration. She denied any changes in her bowel habits. Review of systems was otherwise negative. She is status post sleeve gastrectomy 2 years prior and had a history of a remote laparoscopic cholecystectomy. Physical exam was only notable for mild epigastric tenderness. Laboratory tests showed AST 46 ALT 65 ALK 75, and otherwise normal including lipase. A right upper quadrant ultrasound showed dilation of the common bile duct which was again demonstrated on MRCP. The patient subsequently underwent ERCP with sphincterotomy. A few hours post-operatively, the patient started complaining of severe epigastric and left upper quadrant abdominal pain radiating to the back. She was found to be hypotensive and immediate fluid resuscitation was initiated. Repeat laboratory testing at the time showed a lipase of 1300 as well as hemoglobin dropping from baseline of 12.0 to 7.0. CT scan of the abdomen illustrated a large splenic heterogenous subcapsular hematoma and peripancreatic stranding.(Figure 1) The patient was transferred to the ICU and managed conservatively with fluids and blood transfusions. The hematoma regressed and her hemoglobin remained stable. With clinical improvement, she was discharged home. Splenic injury is hypothesized to occur when the endoscope “bows” in the ‘long' position with torsion on the greater curvature of the stomach while attempting to pass the scope through the duodenum. Calcification or fibrosis from chronic pancreatitis or adhesions from a prior abdominal surgery can make this portion of the procedure more difficult and hence cause more traction. Interestingly, this patient had a sleeve gastrectomy 2 years prior. Special care should be taken when performing ERCP in those particular patients. Additionally, one should maintain a high index of suspicion for splenic injury in a patient who is post-ERCP with hypotension, severe abdominal pain or a drop in hemoglobin.Figure: CT Scan showing a large heterogenous subcapsular splenic hematoma." @default.
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• W2911575549 date "2017-10-01" @default.
• W2911575549 modified "2023-09-27" @default.
• W2911575549 title "ERCP-Induced Splenic Injury in a Patient With Sleeve Gastrectomy" @default.
• W2911575549 doi "https://doi.org/10.14309/00000434-201710001-02041" @default.
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