Splenic Laceration After Endoscopic Retrograde Cholangiopancreatography

Emad Geddoa, MRCS, Nafees A. Qureshi, MRCS, Darren K. Patten, MRCS, Meher Lad, MBBS, Sarah Duncan, MBBS, Neil Foden, MRCP, David L. Stoker, FRCS

Department of General Surgery, North Middlesex University Hospital, London, England (Mr. Geddoa, Dr. Qureshi, Mr. Patten, Dr. Lad, Dr. Duncan, Mr. Stoker). Department of Biosurgery and Surgical Oncology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, England (Mr. Patten).

ABSTRACT

The advent of endoscopic retrograde cholangio-pancreatography (ERCP) has enabled physicians and surgeons to carry out a range of diagnostic and therapeutic procedures pertaining to various pathologies found within the hepato-biliary system. Despite being relatively less invasive when compared to traditional methods of surgery, ERCP still carries recognized complications that are a cause for morbidity amongst patients. Furthermore, rarer complications can occur in difficult circumstances that are potentially fatal. We report two cases whereby the patients sustained serious splenic injuries as a consequence of the procedure. Splenic lacerations were diagnosed on computer tomography scanning in both patients who subsequently underwent emergency splenectomy. The patients made an uneventful recovery and returned home after surgery.

To date twelve cases have been reported in current medical literature regarding injury to the spleen following ERCP. These aforementioned injuries have arisen particularly when the endoscopist has encountered difficult or variations in anatomy whilst performing ERCP. In addition to presenting two cases, we review the literature and discuss the implications of these complications and how this may affect the way in which clinicians take informed consent from patients before conducting ERCP.

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