Retroperitoneal Perforation during ERCP and Endoscopic Sphincterotomy: Causes, Clinical Features and Management

Abstract

Eleven patients with retroperitoneal perforation complicating endoscopic management of bile duct obstruction were seen over a seven-year period. In nine patients endoscopic sphincterotomy or pre-cut papillotomy had been performed, but in two who had not undergone sphincterotomy perforation occurred because of the penetration of a guidewire during attempts to negotiate a malignant bile duct stricture. Eight out of eleven patients remained asymptomatic, and all recovered with conservative management. Asymptomatic retroperitoneal perforation can complicate therapeutic ERCP even when sphincterotomy is not performed, but conservative management is usually effective if the complications is recognized immediately.

Validity of Clinical Criteria in the Management of Endoscopic Retrograde Cholangiopancreatography–Related Duodenal Perforations

“…In accordance with other studies, 4,6,7,10,17,20 our experience showed that the clear demonstration of free retroperitoneal air or leakage during ERCP allowed immediate diagnosis in most patients (80%). In the remaining 4 cases, equivocal findings were confirmed by CT.…”

“…This might potentially ensure better outcomes. 4,6,10,20,21 The present results in patients diagnosed early are comparable with those in other recently published series. 4,5 These results contrast those reported in some other series 8,11,13,16 describing delayed diagnosis in 70% to 75% of cases, in which most of them were managed operatively with unfavorable outcomes.…”

Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations

“…As the performance of upper gastrointestinal endoscopy, especially ERCP has increased everywhere, so has the incidence of iatrogenic intestinal perforation. Duodenal injury is reported to have an incidence of 0.3% to 1.3% [2][3][4], with a relatively high mortality rate of 16% to 18% [5].…”

A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum

“…There are only scarce reports on benign pneumoperitoneum successfully managed with conservative treatment after endoscopic biliary procedures [9] . Regarding the management of ERCP-related duodenal perforations, arguments have been made about both surgical [10][11][12] and non-surgical management [13] . Stapfer and colleagues [14] analyzed fourteen cases of ERCPrelated perforations and concluded that patients with no peritonitis, sepsis, significant contrast medium leak during ERCP or follow-up upper gastrointestinal study, and retro-or intraperitoneal fluid collections during computed tomography, can be successfully managed conservatively.…”