Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy; Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense Garbagnate Milanese, Milan, Italy.
Department of Pathophisiology and Transplantation, University of Milan, Milan, Italy; Department of General Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy.
Dig Liver Dis. 2018 Oct;50(10):997-1003. doi: 10.1016/j.dld.2018.07.010. Epub 2018 Jul 20.
Hepatic hematoma (HH) is a rare but severe adverse event following endoscopic retrograde cholangiopancreatography (ERCP).
To perform a systematic literature review and describe two additional cases, one of which presenting multiple subcapsular/intrahepatic hematomas after ERCP.
The literature review was performed in PubMed/MEDLINE, EMBASE, and SCOPUS to identify all cases reporting on HH after ERCP.
A total of 48 cases (females 63%, mean age 58.2 ± 20.6 years) were included. The mean symptoms onset time was 46.8 h after ERCP, and the most common symptoms were abdominal pain (91.7%), anaemia (43.8%), hypotension (29.2%) and fever (20.8%). All cases were diagnosed by computed tomography (CT). HH was found mostly in the right hepatic lobe (95.1%) and the mean size was 116 × 93 mm. A conservative management was adopted in 38.3% of cases, while percutaneous drainage, embolization and surgery were needed in 31.9%, 14.9% and 25%. Mortality rate was about 9%. Anaemia (OR 6.9; p = 0.02) and surgery (OR 10.5; p < 0.01) were the only independent factors for unfavorable outcome (death), while abdominal pain (OR 0.1; p = 0.03) and antibiotics administration (OR 0.06; p < 0.001) were associated with better outcome.
HH is a rare but severe complication following ERCP which needs a multidisciplinary approach. Antibiotics administration is the only treatment able to reduce the risk of death.
肝血肿（HH）是内镜逆行胰胆管造影术（ERCP）后罕见但严重的不良事件。
进行系统文献回顾，并描述另外两例病例，其中一例 ERCP 后出现多个包膜下/肝内血肿。
在 PubMed/MEDLINE、EMBASE 和 SCOPUS 中进行文献检索，以确定所有报告 ERCP 后发生 HH 的病例。
共纳入 48 例病例（女性占 63%，平均年龄 58.2±20.6 岁）。症状发作时间平均为 ERCP 后 46.8 小时，最常见的症状是腹痛（91.7%）、贫血（43.8%）、低血压（29.2%）和发热（20.8%）。所有病例均经计算机断层扫描（CT）诊断。HH 主要位于右肝叶（95.1%），平均大小为 116×93mm。38.3%的病例采用保守治疗，31.9%、14.9%和 25%的病例需要经皮引流、栓塞和手术治疗。死亡率约为 9%。贫血（OR 6.9；p=0.02）和手术（OR 10.5；p<0.01）是不良结局（死亡）的唯一独立因素，而腹痛（OR 0.1；p=0.03）和抗生素治疗（OR 0.06；p<0.001）与更好的结局相关。
HH 是 ERCP 后罕见但严重的并发症，需要多学科方法处理。抗生素治疗是降低死亡风险的唯一治疗方法。
