S2501 Delayed Post Sphincterotomy Bleed and Clot-Induced Cholangitis: A Rare but Life-Threatening Complication of Endoscopic Retrograde Cholangiopancreatography

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and interventional procedure used in conditions related to the pancreas and biliary tract. It has a complication rate ranging from 4 % to 10 %. Severe complications are few with the most common of them being post-ERCP pancreatitis, post-sphincterotomy bleeding, and perforation. A rare, but potentially life-threatening complication of ERCP is splenic injury. We report the case of a 60-year-old female with choledocholithiasis who sustained splenic decapsulation following ERCP. The exact causes of splenic injury are unknown, although several mechanisms are postulated. A literature review of splenic injuries post-ERCP shows that there are only 3 cases with post-ERCP splenic decapsulation. Our patient is the first one in whom splenic decapsulation occurred without any risk factors or technical difficulties during the procedure. A high index of suspicion for splenic injury is required in any patient who has severe pain, anemia, or hemorrhagic shock after ERCP.

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ERCP-Related Duodenal Perforation Presenting as Pneumoscrotum

Case Reports in Gastroenterology ◽

10.1159/000485557 ◽

2018 ◽

Vol 12 (1) ◽

pp. 1-6

Author(s):

Mohammad Saud Khan ◽

Faisal Jamal ◽

Zubair Khan ◽

Abhinav Tiwari ◽

Hermann Simo ◽

...

Keyword(s):

Supportive Care ◽

Male Patient ◽

Subcutaneous Emphysema ◽

Duodenal Perforation ◽

Close Monitoring ◽

Air Leak ◽

Endoscopic Retrograde ◽

Scrotal Pain ◽

Life Threatening ◽

Life Threatening Complication

Duodenal perforation is a rare but life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). Duodenal perforation can cause air leak into the extraperitoneal space. In rare instances, the air in the extraperitoneal space could dissect along the fascial planes of the abdomen to reach scrotum, leading to pneumoscrotum. We present the case of a 35-year-old male patient who developed scrotal pain and swelling following ERCP. He was found to have extensive pneumoscrotum, pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed with retroperitoneal duodenal perforation. He was managed conservatively with close monitoring and supportive care.

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An unusual experience with endoscopic retrograde cholangiopancreatography

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.132408 ◽

2013 ◽

Vol 04 (04) ◽

pp. 114-116 ◽

Cited By ~ 6

Author(s):

Mallikarjun Patil ◽

Keyur A. Sheth ◽

C. K. Adarsh ◽

B. Girisha

Keyword(s):

Gastrointestinal Tract ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Guide Wire ◽

Rare Complication ◽

Endoscopic Retrograde ◽

Endoscopic Procedures ◽

Hepatic Hematoma ◽

Hemorrhagic Complications ◽

Life Threatening ◽

Therapeutic Utility

AbstractThe endoscopic retrograde cholangiopancreatography (ERCP) is known for its varied diagnostic and therapeutic utility for a variety of disorders. However it has greater likelihood of procedure related complications among the endoscopic procedures of gastrointestinal tract. The extraluminal hemorrhagic complications following ERCP are potentially life threatening though relatively rare. We present a 50 year patient with choledocholithiasis and cholelithiasis developing rare complication of subcapsular hepatic hematoma, following ERCP due to guide wire injury.

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Endoscopic Retrograde Cholangiopancreatography Scope‑induced Duodenojejunal Flexure Perforation: The World’s First Case

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_87_16 ◽

2017 ◽

Vol 08 (03) ◽

pp. 145-147

Author(s):

Jignesh A. Gandhi ◽

Pravin H. Shinde ◽

Basavaraj K. Nagur ◽

Rohan D. Digarse

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Primary Closure ◽

Early Recognition ◽

Emergency Laparotomy ◽

Significant Morbidity ◽

Endoscopic Retrograde ◽

The Third ◽

First Case ◽

Duodenojejunal Flexure ◽

Life Threatening

ABSTRACTDuodenojejunal (DJ) flexure perforation is very rare. DJ flexure perforation following endoscopic retrograde cholangiopancreatography (ERCP) has not be documented till date. They are associated with significant morbidity and mortality. We present an ERCP‑induced DJ flexure perforation which has been treated with primary closure in two layers at our institution. To the best of our knowledge, this is the world’s first case. Such site of ERCP‑induced perforation has not been reported in literature till date. A 75‑year‑old female patient underwent repeated ERCP for obstructive jaundice. There was perforation during the third ERCP while removing the larger stone. Emergency laparotomy was performed with primary closure of perforation in two layers. ERCP‑induced DJ flexure perforation has not yet been documented. It is potentially life‑threatening. Early recognition may lead to a better prognosis through earlier intervention.

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Life threatening hemobilia after endoscopic retrograde cholangiopancreatography (ERCP)

Digestive and Liver Disease ◽

10.1016/j.dld.2017.09.001 ◽

2017 ◽

Vol 49 (12) ◽

pp. 1336-1337 ◽

Cited By ~ 2

Author(s):

Ihab I. El Hajj ◽

Stuart Sherman ◽

Maximilian Pyko ◽

Glen A. Lehman

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Life Threatening

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Role of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis of Choledocholithiasis

Pielegniarstwo XXI wieku / Nursing in the 21st Century ◽

10.1515/pielxxiw-2016-0037 ◽

2016 ◽

Vol 15 (4) ◽

pp. 48-52

Author(s):

Jolanta Borgosz ◽

Bogusława Kupczak-Wiśniowska ◽

Beata Podsiadło ◽

Bogusława Serzysko

Keyword(s):

Literature Review ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Potential Risk ◽

Bile Ducts ◽

Diagnostic Method ◽

Clinical Symptoms ◽

Reference Method ◽

Endoscopic Retrograde ◽

Life Threatening

Abstract Introduction. Retrograde cholangiopancreatography (ERCP) is a validated reference method for detection and treatment of choledocholithiasis. It can be performed at any stage of treatment. It allows for differentiation of bile retention causes, assessment of the level of bile ducts dilation, location of the obstruction level and establishment of recommendations for invasive bile ducts tests. Despite varied course of choledocholithiasis, swift detection and removal of stones from bile ducts should be striven for due to a potential risk of life-threatening complications.Aim. The aim of the study was to evaluate the diagnostic effectiveness of the retrograde cholangiopancreatography in patients with suspected bile ducts choledocholithiasis.Material and methods. Based on the literature review, the retrograde cholangiopancreatography in the diagnostics of bile ducts choledocholithiasis has been evaluated. Identification of choledocholithiasis, regardless of clinical symptoms, is associated with the decision to remove deposits from bile ducts. ERCP is the method of choice.Conclusions. As studies by numerous authors show, cholelithiasis can be the leading cause of cholangitis and pancreatitis. Diagnostic ERCP with evacuation deposits remains the most recommended diagnostic method in such cases.

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Life-threatening Splenic Rupture after Endoscopic Retrograde Cholangiopancreatography

The American Surgeon ◽

10.1177/000313481408000806 ◽

2014 ◽

Vol 80 (8) ◽

pp. 230-231 ◽

Cited By ~ 4

Author(s):

Jessica L. Weaver ◽

Whitney Jones ◽

Keith R. Miller

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Splenic Rupture ◽

Endoscopic Retrograde ◽

Life Threatening

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Emergency Laparoscopic Repair of an Iatrogenic Gastric Perforation in a Hiatal Hernia following a Failed Endoscopic Closure

Case Reports in Surgery ◽

10.1155/2020/5060962 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Benjamin L. Reed ◽

Lawrence E. Tabone ◽

Nova Szoka ◽

Salim Abunnaja

Keyword(s):

Hiatal Hernia ◽

Laparoscopic Repair ◽

Surgical Repair ◽

Gastric Perforation ◽

Endoscopic Retrograde ◽

Endoscopic Procedures ◽

Abdominal Drain ◽

Endoscopic Closure ◽

Life Threatening ◽

Life Threatening Complication

Iatrogenic gastrointestinal perforation is a rare, life-threatening complication of endoscopic procedures, which requires either endoscopic or surgical repair. We report the account of an 82-year-old woman with an iatrogenic gastric perforation of a hiatal hernia secondary to an endoscopic retrograde cholangiopancreatography (ERCP) procedure. Despite immediate recognition of the complication and endoscopic closure with through-the-scope (TTS) clips, the patient developed mediastinitis, peritonitis, and sepsis. She subsequently underwent an emergency laparoscopic hiatal hernia dissection and repair of the perforation with mediastinal and peritoneal washout. Given the patient’s age and the degree of insult, subdiaphragmatic anchoring with abdominal drain placement was performed, and the hiatus was left open for additional drainage. The use of a side-viewing duodenoscope with the presence of a large hiatal hernia contributed to the risk of gastric perforation. We conclude that performing endoscopic procedures in patients with a known hiatal hernia should be carefully undertaken. If a perforation in such patients occurs, laparoscopic repair of such complications is feasible as demonstrated in this case video.

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