Subcapsular hepatic hematoma as a complication of ERCP, what do we know about its etiology?

We present the case of a 79-year-old man who underwent endoscopic retrograde cholangiopancreatography (ERCP) after cholangitis. The papilla was rigid and the biliary tract was dilated with the sharpening of the distal bile duct, without an obvious cause. We placed a plastic stent and purulent bile flowed. Biopsies of the papilla were taken on suspicion of tumour infiltration. The next day, the patient had pain in the right upper quadrant. In the abdominal computed tomography, we found a subcapsular hepatic collection suggestive of a hematoma. Hepatic subcapsular hematoma is a rare but potentially lethal complication of ERCP. There are few cases reported and the pathogenesis is not clear. Most authors think that it is due to the perforation of the intrahepatic bile duct by the guidewire. Other authors propose that the liver damage is secondary to the traction performed by the balloon inside the main bile duct when trying to remove the stones or passing stenosis.