POST ERCP PERFORATION: A CASE REPORT

Year 2019, Volume: 1 Issue: 3, 131 - 132, 23.12.2019

Hasan Gökçe , Muhammed Ekmekyapar , Şükrü Gürbüz , Serdar Derya

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a
commonly used method in the diagnosis and treatment of biliary and pancreatic
channel diseases. Perforation is one of the rare but most feared complications
of endoscopic retrograde cholangiopancreatography. A 90-year-old male patient
was admitted to the emergency department with dyspnea. According to the
anamnesis obtained from the patient, the patient's shortness of breath was
long-lasting, but he had complaints of new onset abdominal pain. When the
patient's anamnesis was deepened, it was learned that he underwent ERCP for
choledocholithiasis 10 days ago. In the physical examination, the patient had
severe pain in the right upper quadrant of the abdomen. Other system
examination findings were normal. In the patient's hemogram, WBC: 20,7 * 10 ^ 9
/ L and biochemical parameters, creatinine were 2.35 mg / dL, but other
biochemical parameters were normal. The CRP of the patient was 15.8 mg / dL (normal
range0.35). Abdominal ultrasonography was requested in accordance with physical
examination and laboratory values. The patient's abdominal ultrasonography
revealed that the gallbladder was of normal size, wall thickness and echo were
normal, and a large number of stone echoes and common bile duct dilated (7 mm).
Then the patient with CRF was asked for noncontrast abdominal CT. Noncontrast
abdominal CT revealed suspicious free air densities in the paraduodenal area
and was first evaluated in favor of intra-retroperitoneal abscess secondary to
duodenum perforation. The patient was referred to the general surgery intensive
care unit.
The diagnosis of duodenal
perforation after ERCP is usually based on physical examination findings,
fluroscopic imaging and in some cases by computed tomography imaging. The
treatment of these perforations should still be discussed. Conservative
treatment methods are preferred in most patients. However, it requires careful
observation and early surgical consultation, as the result may be poor in
patients who are unable to receive fast and appropriate treatment. Perforation should be kept in mind in patients with
abdominal pain starting with endoscopy and ERCP. A careful history and physical
examination in emergency departments can be diagnosed by direct radiography and
computed tomography. Most of the cases diagnosed early can be followed by
conservative treatment. Delayed diagnosis and treatment may have adverse
consequences such as sepsis and death, so early surgical consultation should be
sought.

Keywords

Abdominal pain, perforation, ERCP

References

• 1. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med, 1996; 335: 909-918.
• 2. Enns R, Eloubeidi MA, Mergener K, et al. ERCP-relatedperforations: risk factors and management Endoscopy 2002; 34:293.
• 3. Chung RS, Sivak MV, Ferguson DR. Surgical decisions in the management of duodenal per¬foration complicating endoscopic sphincter¬otomy. Am J Surg, 1993; 165: 700-703.
• 4. Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. AnnSurg 2000; 232:191.
• 5. Wu HM, Dixon E, May GR, Sutherland FR. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review. HPB (Oxford) 2006; 8:393.
• 6. Fatima J, Baron TH, Topazian MD, et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. ArchSurg 2007; 142:448.
• 7. Morgan KA, Fontenot BB, Ruddy JM, et al. Endoscopic retrograde cholangiopancreatography gut perforations: when to wait! When to operate! AmSurg 2009; 75:477.
• 8. Assalia A, Suissa A, Ilivitzki A, et al. Validity of clinical criteria in the management of endoscopic retrograde cholangiopancreatography related duodenal perforations. ArchSurg 2007; 142:1059.
• 9. Howard TJ, Tan T, Lehman GA, et al. Classification and management of perforations complicating endoscopic sphincterotomy. Surgery 1999; 126:658.
• 10. Chaudhary A, Aranya RC. Surgery in perforation after endoscopic sphincterotomy: sooner, later or not at all? Ann R Coll Surg Engl 1996; 78:206.
• 11. Chung RS, Sivak MV, Ferguson DR. Surgical decisions in the management of duodenal perforation complicating endoscopic sphincterotomy. Am J Surg 1993; 165:700.