Retroperitoneal perforation during endoscopic sphincterotomy: imaging findings.
BACKGROUND
Endoscopic retrograde cholangiopancreatography with sphincterotomy has become an important technique in the diagnosis and treatment of biliary and pancreatic diseases. Serious complications, although rare, may occur, and their early recognition and treatment are of the utmost importance. We encountered several such cases. This study reviews the imaging findings in patients with retroperitoneal perforation detected after the procedure.


METHODS
Of 796 patients who had endoscopic sphincterotomy at our institution during a 9-year period, retroperitoneal perforation occurred in nine (1.13%). Imaging findings and clinical outcome were assessed.


RESULTS
In eight patients, routine abdominal radiographs taken during the procedure disclosed retroperitoneal air, associated with extravasation of contrast material in six patients. This was further confirmed on computed tomography (CT) in three patients. In the ninth patient, the diagnosis was established by an emergent abdominal CT performed a day after the sphincterotomy, because of severe abdominal pain. Two patients died of overwhelming sepsis.


CONCLUSIONS
Retroperitoneal perforation during endoscopic sphincterotomy is a rare complication, which occurred in 1.13% of our patients. It can be usually clearly recognized radiographically by an abdominal film and in doubtful cases by CT. We emphasize the importance of recognizing this potentially serious complication with imaging studies.
Zissin
R
R
Department of Diagnostic Imaging, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel.
Shapiro-Feinberg
M
M
Oscadchy
A
A
Pomeranz
I
I
Leichtmann
G
G
Novis
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D012421:Rupture; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed