Endoscopic sphincterotomy-related perforation in the common bile duct successfully treated by placement of a covered metal stent

Abstract

An 82-year-old woman with cholangitis and common bile duct (CBD) stones underwent endoscopic retrograde cholangiopancreatography (ERCP). An endoscopic sphincterotomy was carried out using an electrosurgical unit with a standard pull sphincterotome. Multiple stones were removed using an extraction balloon, and subsequently, the patient had no pain or fever and a chest radiograph showed no free air. However, 2 days later the patient complained of abdominal pain. Computed tomography (CT) revealed retroperitoneal air and fluid (• " Fig. 1). Given her age and poor medical condition, the patient was not considered a surgical candidate. ERCP disclosed a perforation in the distal CBD near the ampulla. Multiple plastic stents were inserted (• " Fig. 2) and she was treated with total parenteral nutrition, broad-spectrum antibiotics, and percutaneous catheter drainage from the right pararenal space. The fever subsided and the patient's condition improved, but there was no decrease in the amount of percutaneous catheter drainage (> 150 mL/day). A tubo

Biliary endoscopic sphincterotomy: Techniques and complications

“…One of them is to close the defect with endoclips and divert bile with nasobiliary tube or plastic stent insertion[60]. Another one is to deploy FC-SEMS, which both seals the defect and diverts the bile[61,62]. FC-SEMS has made a revolution in the treatment of perforation.…”

A comprehensive approach to the management of acute endoscopic perforations (with videos)

“…Perforation of the distal bile duct often can be managed by placement of plastic stents and, more recently, by temporary placement of FCSEMSs. 86 Retroperitoneal air alone (type IV) probably is related to the use of insufflated air to maintain patency of the lumen, although it can occur with small perforations and can be associated with postprocedural pain (Fig. 13).…”

Use of covered self-expandable metal stents for endoscopic management of benign biliary disease not related to stricture (with video)

“…CSEMSs are useful for closure of post-sphincterotomy perforations, 16,17 as seen in our series. Additionally, we found them useful for closure of biliary-enteric anastomotic perforations.…”