Life-threatening duodenal perforation complicating endoscopic retrograde cholangiopanceatography: A case series

Mousa, Hussam; Hefny, Ashraf F.; Abu‐Zidan, Fikri M.

doi:10.1016/j.ijscr.2020.01.001

Cited by 4 publications

(9 citation statements)

References 14 publications

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“…A total of 591 articles were excluded, leaving 54 articles that underwent a full-text review. Most of the studies did not use the Stapfer classification, and as a result only 10 comparative studies [ 1 , 5 , 9 - 16 ] regarding the initial management of post-ERCP perforations were eligible for quantitative analysis.…”

Section: Resultsmentioning

confidence: 99%

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Surgical versus non-operative initial management of post-endoscopic retrograde cholangiopancreatography perforation: a systematic review and meta-analysis

Samara¹

2021

aog

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Background In the present study we performed a systematic review and meta-analysis regarding the initial management of perforations following endoscopic retrograde cholangiopancreatography (ERCP). Method A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Result In total, 10 comparative studies and 223 patients with post-ERCP perforations were included in the present study. In type I and II perforations, the success rate of initial surgical management was higher compared to the non-operative management (NOM) group (P=0.09 and P=0.02, respectively). There was no statistically significant difference in mortality rates or length of hospital stay between initial surgical and NOM management for any type of perforation. Conclusions The current meta-analysis demonstrated the significance of the initial management of patients with post-ERCP perforations. Whether a surgical or an endoscopic approach is chosen, the patient should immediately be evaluated by an experienced surgeon or endoscopist.

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Section: Resultsmentioning

confidence: 99%

“…The main characteristics of the included studies are presented in Table 1 . Nine retrospective studies [ 1 , 5 , 9 - 10 , 12 - 16 ] and a retrospective review of a prospective database [ 11 ] were included in the quantitative analysis. Table 1 also displays demographics information.…”

Section: Resultsmentioning

confidence: 99%

Surgical versus non-operative initial management of post-endoscopic retrograde cholangiopancreatography perforation: a systematic review and meta-analysis

Samara¹

2021

aog

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“…Bleeding and intestinal injuries related to instrumentation are the most common intra‐procedural complications, which could happen even with experienced endoscopists. When these complications occur during the procedure, it can be managed directly either using over or through the scope clip 5 …”

Section: Discussionmentioning

confidence: 99%

“…When these complications occur during the procedure, it can be managed directly either using over or through the scope clip. 5 …”

Section: Discussionmentioning

confidence: 99%

“…Duodenal perforation during ERCP procedure is an absolutely rare complication, a review by Cirocchi et al in 2016 described the incidence of duodenal perforation after ERCP range from 0.09 to 1.67%, and the mortality was reported up to 8% in high‐volume referral center. 5 , 6 The keypoint in the management of duodenal perforation related to ERCP is early diagnosis; early diagnosis and management lead to favorable clinical outcomes with no postoperative morbidity and lower mortality rate. 7 But these kinds of complications sometimes have been diagnosed lately and delayed presentation following with intraperitoneal contamination, even with septic condition.…”

Section: Discussionmentioning

confidence: 99%

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A rare clinical presentation of third part duodenal perforation due to post‐endoscopic retrograde cholangiopancreatography stent migration on advanced stage peri‐ampullary tumor

Bagus

2021

JGH Open

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As a diagnostic and therapeutic treatment role on malignant biliary obstruction, endoscopic retrograde cholangiopancreatography (ERCP) has already been used as a routine procedure, especially for palliative treatment on advanced stage peri‐ampullary tumor. This minimal invasive procedure has many early or late complications such as bleeding, post‐ERCP pancreatitis, perforation, cholangitis, and the rare duodenal perforation from the stent migration. The current review reported the incidence of stent erosion associated with duodenal perforation was only 1% for this palliative procedure. We report a 75 years old male patient with diffuse abdominal tenderness 7 days after palliative ERCP stent placement for malignant biliary obstruction, metal stent could not be placed, and plastic stent placement had been done. There was no post‐ERCP pancreatitis found during the first 24 h. The patient came to the emergency with clinical sign and symptoms of diffuse peritonitis; abdominal X‐ray found no free intraperitoneal air. Exploratory laparotomy was performed, and we found bile leak from the third part of perforated duodenal with 5 mm in diameter, plastic stent exposed from the perforation site, and no active bleeding. We performed primary suture of the duodenum, cholecysto‐enteric bypass, pyloric exclusion, gastro‐jejunostomy bypass, and braun anastomosis. Jejunostomy feeding has been placed. There were no postoperative cardiopulmonary complication, and the patient could tolerate well for oral intake and discharged from hospital at 10th postoperative day (POD). This rare duodenal perforation complication could happen even in plastic stent placement during the ERCP procedure, and early management was needed to gain the favorable outcome.

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Secondary iatrogenic duedonum perforation: a rare complication

ÖZDOĞAN,

AY,

YILMAZ

2024

The European Research Journal

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The incidence of perforations resulting from Endoscopic Retrograde Cholangiography (ERCP) is observed to be less than 1%. In this case report, we aim to present our unique experience as a mechanism, which is even more uncommon. A 68-year-old male with an ASA score of 2 was prediagnosed with a distal common bile duct tumor. ERCP was performed for therapeutic and diagnostic purposes and a 9F 10 cm plastic stent was placed to relieve obstruction. The patient, who had the sudden onset of abdominal pain within the initial 24-hour period following the procedure, underwent surgical intervention subsequent to a computed tomography assessment. In the third portion of the duodenum, an approximately 4 mm perforation originating from the stent was observed during the examination. It was repaired with a 3.0 prolene suture, followed by omentopexy. He was discharged uneventfully on the eighth day. Although duodenal perforation due to the placement of a plastic biliary stent with ERCP is a very uncommon complication, the patient's clinical and imaging findings are essential for treatment planning.

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Life-threatening duodenal perforation complicating endoscopic retrograde cholangiopanceatography: A case series

Cited by 4 publications

References 14 publications

Surgical versus non-operative initial management of post-endoscopic retrograde cholangiopancreatography perforation: a systematic review and meta-analysis

Surgical versus non-operative initial management of post-endoscopic retrograde cholangiopancreatography perforation: a systematic review and meta-analysis

A rare clinical presentation of third part duodenal perforation due to post‐endoscopic retrograde cholangiopancreatography stent migration on advanced stage peri‐ampullary tumor

Secondary iatrogenic duedonum perforation: a rare complication

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