Damage control surgery as a rescue procedure for ruptured hepatic subcapsular hematoma following ERCP for choledocholithiasis in a resource-limited setting: a case report
Year: 2026
Type: article
Study design: Case Report
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.
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W7225737988