Splenic Injury After Therapeutic ERCP

INTRODUCTION: Endoscopic Retrograde Cholagiopancreatography (ERCP) is an invasive, but sensitive means of diagnosing and treating biliary disease. Complications range from 5-10%. The most common complications of ERCP are acute pancreatitis and duodenal perforation; but esophageal, splenic and hepatic injury have been reported. Here we report such a splenic injury after ERCP.

CASE REPORT: A 29 year old female was referred for diagnostic ERCP for recurrent biliary colic and elevated liver function test. The scope was passed easily and the biliary duct cannulated in the first attempt. The cholangiogram showed choledocolithiasis, and a therapeutic sphincterotomy and lithotomy was performed. Post procedure the patient developed abdominal pain that resolved without intervention. The diagnostic work up was suggestive of post-procedure pancreatitis. The patient received a laparoscopic cholecystectomy upon resolution, the findings included a grade I splenic laceration without active bleeding.

DISCUSSION: Although rare, several cases of ERCP related splenic injury have been reported. The first reported case was in 1989, with total of 25 cases reported since then. We discuss the possible implicated mechanism and the alternatives for the management of this unusual complication.

Session: Poster

Program Number: P378

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