A 60-year-old woman, with no personal history of interest, was admitted to the emergency department with symptoms suggestive of cholangitis.
During admission, a magnetic resonance cholangiography showed a 7.7 mm stone enclaved in the choledochal, 4.4 cm from the papilla, with dilatation of the intrahepatic and extrahepatic bile duct.
These findings led to the decision to perform ERCP in which the papilla of Vater was not cannulated.
Two days later, due to persistent jaundice, a new ERCP showed a fresh clot covering the papilla.
After removing it, the biliary tract was closed, observing the calculus described in the magnetic resonance cholangiography, which was extracted after performing a biliary sphincterotomy.
Finally, diplopia was injected into the papilla, which continued with signs of recent bleeding.
Seven days after discharge, the patient returned to the emergency department with fever, abdominal pain and severe asthenia.
Laboratory tests revealed Hb 8.6 g/dl, hematocrit (Hto) 27.2%, leukocytes 10,000 U/ml with 68% polymorphonuclear, platelets 627,000 U/ml, and C-reactive protein 187.4 mg.
Abdominal ultrasound showed a 10 x 6 cm hepatic space occupying lesion (LOE) in segment III, with ultrasound characteristics of abscess.
Percutaneous drainage was attempted, which was not possible due to the density of the lesion.
A needle biopsy was performed and culture of the material was isolated cloacae.
An abdominal CT scan after antibiotic treatment showed the previously described lesion corresponding to a possible hepatic hematoma.
Persistence of high fever was established with an 8 Fr drainage catheter.
After drainage, the patient was asymptomatic, apyretic and hemodynamically stable.
Weekly abdominal ultrasounds were performed to control the evolution of the hematoma, which showed a progressive decrease.
After six weeks, drainage was removed without complications.
