Splenic hematoma following ERCP for obstructive jaundice requiring splenectomy: a case report and literature review.

Introduction and importance: Splenic injury following endoscopic retrograde cholangiopancreatography (ERCP) is an exceptionally rare but potentially life-threatening complication. Case presentation: We report the case of a female patient admitted with obstructive jaundice and suspected periampullary malignancy associated with markedly elevated CA 19-9 levels. Following ERCP, abdominal computed tomography demonstrated a large subcapsular splenic hematoma. The patient underwent splenectomy, cholecystectomy, hepaticojejunostomy, and Roux-en-Y reconstruction. Histopathological examination confirmed traumatic splenic injury without evidence of malignancy. The postoperative course was complicated by pancreatic fistula, which was successfully managed conservatively. Clinical discussion: ERCP-related splenic injury remains a rare complication with nonspecific clinical manifestations that may delay diagnosis. A review of the literature demonstrates substantial variability in clinical presentation and management, ranging from conservative treatment to splenectomy. Conclusion: This case highlights the diagnostic challenge of ERCP-related splenic hematoma in patients undergoing evaluation for suspected pancreatic head malignancy. Early recognition, prompt cross-sectional imaging, and individualized multidisciplinary management are essential for achieving favorable outcomes. In selected patients, modification of the operative strategy according to intraoperative findings may be lifesaving.