We report the case of a 37-year-old woman who was scheduled for ERCP due to cholelithiasis diagnosed by magnetic resonance cholangiopancreatography (MRI) one week earlier.
At admission, the patient was asymptomatic.
The patient had no personal or family history of interest.
The physical examination revealed marked cutaneous-mucosal jaundice.
Analytical analysis showed: total bilirubin (BT) 7.91 mg/dl, bilirubin (BD) 7.13 mg/dl, alanine alanine aminotransferase (AST) 33 U/GT207, alanine aminotransferase (AST).
ERCP showed a small papilla, difficult to cannulate, which appeared twice to the pancreatic duct.
A precut was made and access to the common bile duct was achieved, with an impacted calculus of about 2 cm in diameter.
A wide papillotomy was performed and the calculus was extracted with the help of Fogarty balloon, and the rest were retained bile leaking with some pus.
Six hours after ERCP, the patient developed severe diffuse abdominal pain associated with general malaise.
He had no fever or dysthermic sensation.
An urgent analytical showed an amylase of 1702 U/l without other alterations.
Acute pancreatitis was diagnosed after ERCP, indicating serum therapy, absolute diet, analgesic perfusion and constant monitoring.
A few hours later, the patient suffered a presyncopal picture with persistent general malaise and severe abdominal pain. Blood pressure (BP) of 85/45 mmHg, heart rate (HRO) of 120 bpm and blood pressure (BP) were measured.
A new analytical showed a marked decrease in hemoglobin (Hb) from 12 to 7.6 g/dl, together with hypercholesterolemia already known, without elevation of acute phase reactants or other alterations.
The patient had not presented melenic bowel movements nor evidence of externalization of the bleeding.
Due to these findings, computed tomography (CT) was requested to rule out possible complications.
In the images of the large hepatic lobes, there was evidence of right/intraparetic hematoma, one lobe in the left hepatic lobe and 70 x 107 x 120 mm lobe, and the other lobe affected (HD).
A small amount of subphrenic intraparenchymal air was observed in contact with the DHL collection.
Hepatic artery and portal vein patency was observed, and no contrast extravasation was observed.
The patient was admitted to the Intensive Care Unit for stabilization and control. She was treated with antibiotics and antibiotics.
An urgent arteriography showed no contrast extravasation.
Since the patient was satisfactorily diagnosed with sepsis, and was apyretic and in good general condition, maintaining stable hemoglobin levels, it was decided to maintain an expectant attitude.
At two weeks he continued to be apyretic and without evidence of rebleeding, so he was discharged.
The patient underwent monthly reviews in consultation with analytical and ultrasound control, without observing clinical or analytical impact and showing progressive decrease in the size of the lesions in imaging controls.
Six months after discharge, a new control abdominal CT scan was performed. The control CT scans persisted in approximately 2.8 x 2.3 x 8.5 cm, located in the anteroposterior region above the right and left liver lobes (2.6 x 11 cm, respectively).
