Damage control surgery as a rescue procedure for ruptured hepatic subcapsular hematoma following ERCP for choledocholithiasis in a resource-limited setting: a case report
- 1Department of General Surgery, Hospital de Puerto Barrios, Instituto Guatemalteco de Seguridad Social, Puerto Barrios, Guatemala
- 2Department of Internal Medicine, Hospital de Puerto Barrios, Instituto Guatemalteco de Seguridad Social, Puerto Barrios, Guatemala
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.
Case 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.
Clinical 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.
Conclusion:: 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.
Related
- HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets)-Associated Subcapsular Hepatic Hematoma Presenting as Postoperative Hemorrhagic Shock: A Case Report
- Percutaneous closure of ruptured sinus of Valsalva and tricuspid paravalvular leak following surgical tricuspid valve replacement.
- A Rare Case of Mediastinal Hematoma Causing Mass Effect Following Transradial Access for Coronary Angiography
- Complications and management of thyroglossal duct cyst following Sistrunk procedure in children: a single-center retrospective study in Shanghai, China
- Be aware of the tuft of hair: traumatic lumbar intradural hematoma following spinal anesthesia in a case of occult spinal dysraphism. Illustrative case
BibTeX
@article{munchmeyer2026damage,
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}},
author = {Mónica Waleska Flores Münchmeyer and Mildred Erminda Calel Anaya and Adolfo Antonio Borelly Acevedo Zelada},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000001123},
url = {https://doi.org/10.1097/rc9.0000000000001123},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Damage control surgery as a rescue procedure for ruptured hepatic subcapsular hematoma following ERCP for choledocholithiasis in a resource-limited setting: a case report
AU - Mónica Waleska Flores Münchmeyer
AU - Mildred Erminda Calel Anaya
AU - Adolfo Antonio Borelly Acevedo Zelada
PY - 2026
DA - 2026/10/21
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001123
UR - https://doi.org/10.1097/rc9.0000000000001123
AB - 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. Case 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. Clinical 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. Conclusion:: 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.
SN - 2210-2612
ER -