Surgical Management of Duodenal Perforation Post Endoscopic Retrograde Cholangiopancreatography Series of Cases

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is the most important non-surgical procedure in serious pancreatic and biliary diseases, still burdened with the risk of severe complications. The objective of the study was to distinguish factors which could increase the risk of occurrence of ERCP complication in the form of pancreatitis.The study included 452 patients who had undergone ERCP. Patients’ records were retrospectively analyzed from the aspect of demographic data, indications for the procedure, type and course of the procedure, type and severity of complications, width of the common bile duct (CBD), concomitant diseases and administered medicines which might increase the risk of complications.In 35 patients (7.7%) a complication occurred in the form of pancreatitis (AP). A severe course was confirmed in 11 patients (31%). Cholelithiasis constituted approximately 2/3 of indications for ERCP. AP after ERCP was significantly more often observed in the group of patients aged under 40 (22.9% vs 8.6%; p<0.05). Narrow biliary ducts (3-8 mm) were the factor increasing the frequency of development of AP (25.9% vs 45%; p<0.05). Death occurred in 5 patients (1.1%), including 4 patients (0.96%) in the group without complications, and in 1 patient (2.85%) with complicated AP.ERCP is a very valuable procedure in clinical treatment; however, it is burdened with the risk of complications, such as AP, bleeding, or duodenal perforation. A group especially exposed to the risk of complications in the form of AP are young patients aged under 40 with a narrow CBD.

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Management of duodenal perforation after endoscopic retrograde cholangiopancreatography

Gastroenterology ◽

10.1016/s0016-5085(98)85813-7 ◽

1998 ◽

Vol 114 ◽

pp. A1428

Author(s):

M.V. Stapfer ◽

R. Yang ◽

N. Jabour ◽

S.C. Stain ◽

R. Selby ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Duodenal Perforation ◽

Endoscopic Retrograde

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A Novel Cause of Biliary Peritonitis after Endoscopic Retrograde Cholangiopancreatography: Case Report and Literature Review

Case Reports in Gastrointestinal Medicine ◽

10.1155/2021/3814080 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Andrija Karačić ◽

Paula Batur ◽

Domagoj Štritof ◽

Taro Fukui ◽

Branko Bakula ◽

...

Keyword(s):

Bile Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Intrahepatic Bile Duct ◽

Liver Parenchyma ◽

Duodenal Perforation ◽

Emergency Laparotomy ◽

Endoscopic Retrograde ◽

Biliary Peritonitis ◽

First Case ◽

Therapeutic Ercp

Background. Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1%) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract. Conclusions. This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patient’s wellbeing.

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Fatal Pneumothorax Secondary to Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography

Journal of Medical Cases ◽

10.14740/jmc1700w ◽

2014 ◽

Author(s):

Rana

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Duodenal Perforation ◽

Endoscopic Retrograde

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Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

Clinical Endoscopy ◽

10.5946/ce.2016.112 ◽

2017 ◽

Vol 50 (2) ◽

pp. 202-205 ◽

Cited By ~ 2

Author(s):

Keunmo Kim ◽

Eun Bee Kim ◽

Yong Hyeok Choi ◽

Youngmin Oh ◽

Joung-Ho Han ◽

...

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Duodenal Perforation ◽

Endoscopic Retrograde ◽

Band Ligation ◽

Endoscopic Band Ligation

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Successful Endoscopic Closure of a Large Duodenal Perforation Caused by Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP)

The American Journal of Gastroenterology ◽

10.14309/00000434-201410002-02135 ◽

2014 ◽

Vol 109 ◽

pp. S623

Author(s):

Enqiang Linghu ◽

You Zhang

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Duodenal Perforation ◽

Endoscopic Retrograde ◽

Endoscopic Closure

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Pneumoperitoneum after Endoscopic Retrograde Cholangiopancreatography due to Rupture of Intrahepatic Bile Ducts and Glisson’s Capsule in Hepatic Metastasis: A Case Report and Review of Literature

Case Reports in Gastroenterology ◽

10.1159/000481163 ◽

2017 ◽

Vol 11 (3) ◽

pp. 603-609

Author(s):

Zubair Khan ◽

Umar Darr ◽

Mohamad Nawras ◽

Muhammad Bawany ◽

Jacob Bieszczad ◽

...

Keyword(s):

Case Report ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Hepatic Metastasis ◽

Bile Ducts ◽

Pancreatic Neuroendocrine Tumor ◽

Duodenal Perforation ◽

Metallic Stent ◽

Endoscopic Retrograde ◽

Intrahepatic Bile Ducts ◽

Covered Metallic Stent

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been proven to be a safe and effective method for diagnosis and treatment of biliary and pancreatic disorders. Major complications of ERCP include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. We report a third case in literature of pneumoperitoneum after ERCP due to rupture of intrahepatic bile ducts and Glisson’s capsule in a peripheral hepatic lesion. Case Report: A 50-year-old male with a history of metastatic pancreatic neuroendocrine tumor and who had a partially covered metallic stent placed in the biliary tree 1 year ago presented to the oncology clinic with fatigue, abdominal pain, and hypotension. He was planned for ERCP for possible cholangitis secondary to obstructed previously placed biliary stent. However, the duodenoscope could not be advanced to the level of the major papilla because of narrowed pylorus and severely strictured duodenal sweep. Forward-view gastroscope was then passed with careful manipulation to the severely narrowed second part of the duodenum where the previously placed metallic stent was visualized. Balloon sweeping of stenting was done. Cholangiography did not show any leak. Following the procedure, the patient underwent CT scan of the abdomen that showed pneumoperitoneum which was communicating with pneumobilia through a loculated air collection in necrotic hepatic metastasis perforating Glisson’s capsule. The patient was managed conservatively. Conclusion: In our case, pneumoperitoneum resulted from rupture of intrahepatic bile ducts and Glisson’s capsule in hepatic metastasis. This case emphasizes the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP.

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