An 82-year-old woman with a history of hypertension, atrial fibrillation on anticoagulant therapy, diabetes mellitus and chronic renal failure.
She was admitted due to obstructive jaundice secondary to cholelithiasis.
Therapeutic ERCP was performed with conscious sedation (midazolam-propofol and remifentanil), technically laborious, lasting 150 minutes.
A sudden onset of hemodynamic and respiratory instability at the end of the intervention.
An abdominal computerized axial tomography (CAT) with direct intravenous contrast was performed urgently, in which a hypervascular image in the anterior pole of the spleen was also observed, compatible with a zone of fluid contusion left abdominal gout.
The patient was transferred to the operating room with deterioration of his general condition.
Emergency laparotomy was performed, evading hemoperitoneum of 2000 ml by tearing at the anterior splenic border in the area visualized by CT.
She underwent hysterectomy, cholecystectomy, duodenostomy and removal of the biliary mold with subsequent placement of Kher tube.
No evidence of duodenal perforation.
1.
Postoperatively, the patient developed septic shock due to biliary peritonitis, empirically treated with piperacillin-tazodone, requiring laparotomy. A biliary fistula was found due to Kher's tube exit.
She was discharged from the resuscitation unit 12 days after admission.
The pathology report of the resected piece revealed the existence of a solution of continuity of the capsule on its internal face.
The rest of the parenchyma did not present alterations.
