Etiologies and risks of splenic decapsulation after endoscopic retrograde cholangiopancreatography: case report and literature review

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and interventional procedure used in conditions related to the pancreas and biliary tract. It has a complication rate ranging from 4 % to 10 %. Severe complications are few with the most common of them being post-ERCP pancreatitis, post-sphincterotomy bleeding, and perforation. A rare, but potentially life-threatening complication of ERCP is splenic injury. We report the case of a 60-year-old female with choledocholithiasis who sustained splenic decapsulation following ERCP. The exact causes of splenic injury are unknown, although several mechanisms are postulated. A literature review of splenic injuries post-ERCP shows that there are only 3 cases with post-ERCP splenic decapsulation. Our patient is the first one in whom splenic decapsulation occurred without any risk factors or technical difficulties during the procedure. A high index of suspicion for splenic injury is required in any patient who has severe pain, anemia, or hemorrhagic shock after ERCP.

• References

• 1 Suissa A, Yassin K, Lavy A. et al. Outcome and early complications of ERCP: a prospective single center study. Hepatogastroenterology 2005; 52: 352-355
• 2 Cotton PB, Garrow DA, Gallagher J. et al. Risk factors for complications after ERCP: A multivariate analysis of 11,497 procedures over 12 Years. Gastrointestinal Endoscopy 2009; 70: 80-88
• 3 Chavalitdhamrong D, Donepudi S, Pu L. et al. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc 2014; 26: 15-22
• 4 Kwon CI, Song SH, Hahm KB. et al. Unusual complications related to endoscopic retrograde cholangiopancreatography and its endoscopic treatment. Clin Endosc 2013; 46: 251-159
• 5 Montenovo M, Javed E, Bakthavatsalam R. et al. Splenic Subcapsular Hematoma After Endoscopic Retrograde Cholangiopancreatography in a Liver Transplant Recipient: Case Report and Literature Review. Exp Clin Transplant 2017; 15: 103-105
• 6 Lee R, Huelsen A, Saad N. et al. Splenic Injury Following Endoscopic Retrograde Cholangiopancreatography: A Case Report and Literature Review. Case Rep Gastroenterol 2017; 11: 241-249
• 7 Gaffney RR, Jain V, Moyer MT. Splenic Injury and ERCP: A Possible Risk for Patients with Advanced Chronic Pancreatitis. Case Rep Gastroenterol 2012; 6: 162-165
• 8 Geddoa E, Qureshi NA, Patten DK. et al. Splenic Laceration After Endoscopic Retrograde Cholangiopancreatography. CRSLS; 2014: 1-6
• 9 Zyromski NJ, Camp CM. Splenic injury: a rare complication of endoscopic retrograde cholangiopancreatography. Am Surg 2004; 70: 737-739
• 10 Wu WC, Katon RM. Injury to the liver and spleen after diagnostic ERCP. Gastrointest Endosc 1993; 39: 824-827