INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is indispensable in everyday surgical practice.Despite this, as an invasive procedure, it has its own mortality and morbidity, the most feared of which is periduodenal perforations. Our experience with ERCP related periduodenal perforations and its treatment strategies are presented. Additionally, a rarely encountered subtype is highlighted. METHODS Patients who underwent ERCP and sustained a periduodenal perforation between August 2008 and October 2011 were reviewed. RESULTS During the period from August 2008 to October 2011, 597 ERCP procedures were performed in our hospital. Ten of these patients (3 male, 7 female) had a perforation. The mean patient age was 56.6 years. During the procedure, injury was suspected in four patients; it passed unnoticed in the remaining six. The decision to operate or follow a conservative policy was based on a combination of clinical and radiological findings. Operative intervention was required in three patients, with one mortality, while conservative treatment was followed in the remaining seven. A laparotomy was performed early in two patients whereas it was performed after an initial period of conservative treatment in one. The presence of periduodenal fluid collection, contrast extravasation or free intraperitoneal air were decisive factors for performing laparotomy. CONCLUSIONS ERCP-related periduodenal perforations include different categories. Certain types require operative repair while others should be treated conservatively. The choice of the management approach should be individualised, depending on the clinical picture and radiological findings. Although rare, these are potentially serious complications that may end fatally. Early recognition and appropriate intervention is the only way to avert a fatal outcome.

Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage.

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Aim: Two port laparoscopic placement of peritoneal dialysis (PD) catheter is a new and promising technique which is reliable, efficient and with less complications. Materials and methods:Data collection was done using the internet via Google search engine, Medscape, PubMed, SAGES, Springer, NCBI, Nefrolgia and International journal of peritoneal dialysis. At least five study groups were analyzed who used two ports laparoscopy for PD catheter placement from 2004 to 2010.Results: Mean operating time was between 32 and 52 minutes. No other technical intra or early postoperative complications related to technique were reported. Surgical revision was required in 6%, catheter survival was 94, 87 and 72% after 6 months, 1 and 2 years survival, catheter leakage was between 0 and 22.2%, catheter outflow failure was between 0 and 7.6%, catheter migration was between 2.6 and 4%, no life-threatening bleeding was noted, peritonitis was between 6.5 and 13% and exit site infection was seen in 3% of the patients. Mean follow-up was between 17 months and 2 years. Conclusion:Two port laparoscopic PD catheter insertion is a safe, reproducible, and effective technique. It allows inspection of the abdominal cavity and adhesiolysis, omentectomy, or omentopexy when necessary. Due to its reliability, offers good catheter function outcome.