{
  "abstract": "Introduction:: Hepatic subcapsular hematoma is a rare but potentially life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). Rupture with hemorrhagic shock requiring staged damage-control surgery is exceptionally uncommon.\n\nCase presentation:: A 23-year-old woman underwent ERCP with sphincterotomy, balloon extraction of a 10 mm common bile duct stone, and plastic biliary stent placement. After an approximately 6-hour interhospital transfer, she arrived with pallor, diaphoresis, dyspnea, nausea, vomiting, profound hypotension (60/30 mmHg), and tachycardia (125 beats per minute), but no abdominal pain. Hemoglobin decreased from 9.6 g/dL before ERCP to 6.6 g/dL before surgery. Computed tomography (CT) showed intraperitoneal fluid and extensive right hepatic subcapsular hemorrhagic changes without hollow viscus perforation or pancreatic inflammation. Emergency laparotomy revealed a ruptured right hepatic subcapsular hematoma and 900 mL of hemoperitoneum. Perihepatic packing and two staged re-explorations achieved definitive hemorrhage control.\n\nClinical discussion:: Transfer for angioembolization was unsafe because of ongoing shock, a minimum 6-hour journey, and the unavailability of interventional radiology on weekends. Damage control surgery provided rapid control of diffuse hepatic bleeding. The patient recovered without organ failure or delayed complications.\n\nConclusion:: Post-ERCP hepatic subcapsular hematoma should be considered in cases of unexplained anemia or hemodynamic instability, even without abdominal pain. CT should not delay definitive hemorrhage control. When embolization is unavailable or transfer is unsafe, perihepatic packing with planned re-exploration can be lifesaving.",
  "abstract_shown": true,
  "affiliations": [
    "Department of General Surgery, Hospital de Puerto Barrios, Instituto Guatemalteco de Seguridad Social, Puerto Barrios, Guatemala",
    "Department of Internal Medicine, Hospital de Puerto Barrios, Instituto Guatemalteco de Seguridad Social, Puerto Barrios, Guatemala"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Mónica Waleska Flores Münchmeyer",
      "orcid": "0009-0001-7511-0613"
    },
    {
      "affs": [
        0
      ],
      "name": "Mildred Erminda Calel Anaya",
      "orcid": "0009-0000-5506-558X"
    },
    {
      "affs": [
        1
      ],
      "name": "Adolfo Antonio Borelly Acevedo Zelada",
      "orcid": "0009-0000-6521-9765"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8kndfeq4wbjmh.bib",
  "cited_by": 0,
  "doi": "10.1097/rc9.0000000000001123",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13747573/",
  "id": "8kndfeq4wbjmh",
  "issns": [
    "2210-2612"
  ],
  "landing_url": "https://doi.org/10.1097/rc9.0000000000001123",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2715|Gallbladder and Bile Duct Disorders"
    ]
  ],
  "openalex": "W7225737988",
  "pdf_url": "https://europepmc.org/articles/PMC13747573?pdf=render",
  "pmcid": "PMC13747573",
  "pmid": "43006106",
  "published": "2026-10-21",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/8kndfeq4wbjmh.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T12:23:36Z",
      "native_id": "PMC13747573",
      "source": "pmc",
      "url": "https://doi.org/10.1097/rc9.0000000000001123"
    },
    {
      "first_seen": "2026-11-12T15:22:43Z",
      "native_id": "MED:43006106",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43006106"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2715|Gallbladder and Bile Duct Disorders",
      "subfield": "general"
    }
  ],
  "title": "Damage control surgery as a rescue procedure for ruptured hepatic subcapsular hematoma following ERCP for choledocholithiasis in a resource-limited setting: a case report",
  "title_text": "Damage control surgery as a rescue procedure for ruptured hepatic subcapsular hematoma following ERCP for choledocholithiasis in a resource-limited setting: a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T03:20:44Z",
  "url": "https://research.draconitic.com/paper/8kndfeq4wbjmh",
  "venue": "International Journal of Surgery Case Reports",
  "versions": []
}