Successful Conservative Treatment of an Elderly Patient With an Ercp-Related Duodenal Perforation Associated With Widespread Subcutaneous Emphysema

Li, Xiaoqing; Peng, Qing-Hai; Zhang, Qiongying; Liu, Yi; Du, Zhiqiang; Wang, Chunhui

doi:10.1097/sga.0000000000000260

Cited by 2 publications

(1 citation statement)

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“…Perforation is one of the rare complications, but it is a severe complication, even with life-threatening conditions [ 7 , 10 ] The significant risk factors for ERCP-related perforation are sphincter of Oddi dysfunction (SOD), Billroth II anatomy, intramural injection of contrast, prolonged duration of the procedure, biliary stricture dilation, the experience of the endoscopist, and other anatomical anomalies [ 7 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Pneumo-peritoneum, pneumo-retroperitoneum and subcutaneous emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy—an uncommon complication case report

Premakrishna,

Gobishangar,

Nilojan

et al. 2024

Journal of Surgical Case Reports

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Endoscopic retrograde cholangiopancreatography (ERCP) is invasive for pancreaticobiliary diseases. Perforation is a rare but severe complication among its associated risks. A 45-year-old female with biliary colic and multiple gallbladder calculi was diagnosed with choledocholithiasis based on imaging showing CBD dilation and gallstones. ERCP was planned for stone removal. Sphincterotomy was performed, but stone retrieval attempts failed, leading to severe pneumo-peritoneum and respiratory compromise. Immediate CBD stenting was done, avoiding surgical intervention. The patient recovered uneventfully, later undergoing laparoscopic cholecystectomy with CBD exploration and stone removal. ERCP-related perforations, rare but severe, involve retroperitoneal air collection. Clinical signs include abdominal discomfort, and imaging confirms diagnosis. Management varies by type, with some requiring surgical repair. Conservative management sufficed in this case, with successful patient recovery. ERCP-related complications like pneumo-peritoneum require prompt diagnosis and conservative management if no perforation is evident.

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