Management of Duodenal Perforations after Endoscopic Retrograde Cholangiopancreatography

Kim, Jong Hyun; Lee, Keon Young; Ahn, Seung Ik; Hong, Kee Chun; Jung, Seok; Lee, Don Haeng; Choe, Yun Mee; Choi, Sun Keun; Hur, Yoon Seok; Kim, Sei Joong; Cho, Young Up; Shin, Seok Hwan; Kim, Kyung Rae

Abstract

BACKGROUND/AIMS
Surgery has been the mainstay of treatment for duodenal perforations after the introduction of endoscopic retrograde cholangiopancreatography (ERCP). Yet there have recently been arguments that conservative management with or without endoscopic intervention may be possible and safe.
METHODS
For the patients who received ERCP at Inha University Hospital from Jan. 2001 to Dec. 2007, we retrospectively analyzed the clinical manifestations, the treatment and the clinical outcomes of the cases with duodenal perforation.
RESULTS
Among the 1708 ERCP cases, duodenal perforation occurred in eleven (0.6%) patients. There were two cases of duodenal perforations (type I), four cases of peri-Vaterian injury (type II), two cases of bile duct perforations (type III) and three cases of retroperitoneal perforations (type IV). Six patients (55%) were treated surgically while the others were managed conservatively. Except for one death (9.1%), ten patients fully recovered. Either residual diseases or fluid collections, as seen on CT, were present in the surgically managed patients. The median time interval between ERCP and surgery was 19 hours (range: 8~30 hours).
CONCLUSIONS
To decide on the management of duodenal perforation after ERCP, the presence of residual disease or the leakage of intraluminal contents should be considered along with the type of the perforation.