[Retro-duodenal papillary perforation after endoscopic sphincterotomy. Role of surgical treatment by exclusion of the duodenum. Apropos of 3 cases].
Among the complications of endoscopic sphincterotomy whose rate is about 10% of cases, the retroduodenal papillary perforation represents about 1% of cases. The diagnosis lies on radiological examination which may show during the sphincterotomy the extravasation of the contrast fluid used for the retrograde cholangiography; it can be suggested by the presence of clinical signs of retroperitoneal sepsis or peritonitis. The treatment depends on the severity or peritonitis. The treatment depends on the severity of the clinical symptomatology; it is generally a medical treatment associating nasogastric aspiration and antibiotherapy, and more rarely a surgical one. There is no consensus concerning surgical modalities. We report 3 cases of retroduodenal papillary perforation treated surgical by a duodenal exclusion aiming to transform a complex fistula in a bilio-pancreatic fistula which can be more easily managed by somatostatine-like drugs.
Meyer
C
C
Service de Chirurgie Générale et Digestive, C.H.U. de Strasbourg-Hautepierre.
Jobard
D
D
Thiry
L
L
De Manzini
N
N
Rohr
S
S
D000368:Aged; D000714:Anastomosis, Surgical; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012086:Reoperation; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
Perforation papillaire rétroduodénale après sphinctérotomie endoscopique. La place du traitement chirurgical par exclusion du duodénum. A propos de 3 cas.