Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2022; 14(5): 335-341
Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.335
Endoscopic ultrasonography drainage and debridement of an infected subcapsular hepatic hematoma: A case report
Theo Doyon, Thibault Maniere, Étienne Désilets
Theo Doyon, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke J1H 7N4, Québec, Canada
Thibault Maniere, Étienne Désilets, Department of Gastroenterology, Hopital Charles-Lemoyne, Greenfield Park J4V 2H1, Québec, Canada
Author contributions: Doyon T, Manière T and Désilets E contributed equally to this work.
Informed consent statement: The patient signed an informed written consent form for all the information that is found in this case report, and for all the procedures he went through.
Conflict-of-interest statement: All authors disclosed no financial relationships relevant to this publication.
CARE Checklist (2016) statement: This case report was written according to the CARE Checlist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theo Doyon, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke J1H 7N4, Québec, Canada. theo.doyon@usherbrooke.ca
Received: December 6, 2021
Peer-review started: December 6, 2021
First decision: January 12, 2022
Revised: January 25, 2022
Accepted: April 26, 2022
Article in press: April 26, 2022
Published online: May 16, 2022
Processing time: 160 Days and 17 Hours
Abstract
BACKGROUND

Endoscopic ultrasonography (EUS) has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure. EUS is now used as an alternative technique to percutaneous and surgical drainage. Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage, there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.

CASE SUMMARY

We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma (SHH) of the left lobe following percutaneous biliary drainage. After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery, we conducted a EUS drainage and debridement of the SHH. Using a lumen apposing metal stent (LAMS) by a transgastric approach, we were able to gain endoscopic access to the SHH. With our experience in the debridement of walled off pancreatic necrosis using this technique, we were confident it was the right approach. After four debridement sessions, the computed tomography scan showed a clear regression of the SHH.

CONCLUSION

To our knowledge, this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.

Keywords: Intervention endoscopic ultrasonography; Complication; Hepatic subcapsular hematoma; Transmural drainage; Lumen apposing metal stent; Case report

Core Tip: We conducted an endoscopic ultrasonography drainage and debridement of a subcapsular hepatic hematoma (SHH). Using a lumen apposing metal stent (LAMS) with a transgastric approach, we were able to gain endoscopic access to the SHH. With our experience in the debridement of walled off pancreatic necrosis using this technique, we were confident it was the right approach. After four sessions of debridement, the computed tomography scan showed a clear regression of the SHH. To our knowledge, this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.