Research study · DEN Open · 2027
Intra‐Abdominal Hemorrhage Following Endoscopic Retrograde Cholangiopancreatography in a Patient with a Cascade Stomach: A Case Report
Verified on PubMed Clinical Evidence Analysis
A 2027 study in DEN Open tested cannabinoids. It is rare, but it can happen. This is a single patient, so it shows that internal bleeding can follow this procedure but cannot tell us how often it happens or what caused it for certain.
In plain language
Study overview
This report describes one older man who needed a procedure to clear a blocked bile duct. The doctors had to guide a tube through a stomach that was folded into an unusual shape.
Findings
It is rare, but it can happen. Two hours after the procedure, the man bled inside his abdomen, and he recovered with blood transfusions and by stopping his blood-thinning medicine.
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The deeper readScientific analysis
Intra-abdominal hemorrhage is an extremely rare complication of endoscopic retrograde cholangiopancreatography (ERCP). We report a case of intra-abdominal bleeding that occurred after ERCP for choledocholithiasis with cholangitis in a patient with a cascade stomach. A man in his 70s underwent ERCP for severe acute cholangitis due to a common bile duct stone. The procedure was initially attempted using a TJF-260 V duodenoscope (Olympus); however, insertion into the duodenum was difficult because of the stomach cascade. The scope was changed to a JF-260 V (Olympus), and duodenal access was successfully achieved using a large-diameter sliding tube (ST-CB1; Olympus), followed by biliary stent placement. No sphincterotomy or other invasive procedure was performed. Two hours after the procedure, the patient developed severe epigastric pain, hypotension, and progressive anemia. Contrast-enhanced computed tomography (CT) revealed a large hematoma centered on the gastrosplenic ligament, indicating an intra-abdominal hemorrhage that was likely caused by a traction injury resulting from scope manipulation. No evidence of contrast extravasation was found, and conservative management was performed. The patient's condition improved with blood transfusion and discontinuation of aspirin, and follow-up CT demonstrated resolution of the hematoma. Inserting a scope can be challenging owing to anatomical deformities such as a cascade stomach, and excessive torque or traction may result in vascular injury. Careful insertion using a sliding tube and positional adjustment are essential, with awareness that intra-abdominal hemorrhage, although rare, can be a serious complication.
The paper
Citation
Miura M, Okano N, Ohara Y, Ikegami R, Ujita W, Nakagawa H, et al. Intra‐Abdominal Hemorrhage Following Endoscopic Retrograde Cholangiopancreatography in a Patient with a Cascade Stomach: A Case Report. DEN Open (2027). PubMed 42137240 · DOI
Limitations the authors noted
Single case report with no control group, so causation cannot be established. No angiography performed, so the bleeding vessel was not confirmed. Concurrent aspirin use and scope-related traction are confounded contributors. Authors acknowledge limited literature on cascade stomach-associated ERCP hemorrhage.
In practice
Why this matters
This is a single patient, so it shows that internal bleeding can follow this procedure but cannot tell us how often it happens or what caused it for certain. Clinicians may take from it that sudden belly pain, low blood pressure or falling blood counts after this procedure deserve prompt attention, especially in people with an unusually shaped stomach or those taking aspirin. It leaves open how often this occurs, whether the scope handling or the aspirin was the main cause, and which technique best prevents it.
Frequently asked questions
Clinical Questions & Answers
What were the primary clinical findings in this clinical evaluation of Cannabinoids?
It is rare, but it can happen. Two hours after the procedure, the man bled inside his abdomen, and he recovered with blood transfusions and by stopping his blood-thinning medicine.
What study limitations or clinical safeguards should patients keep in mind?
Single case report with no control group, so causation cannot be established. No angiography performed, so the bleeding vessel was not confirmed. Concurrent aspirin use and scope-related traction are confounded contributors.
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Reviewed by Dr. Caplan on October 24, 2026.
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