[Conservative management of duodenal perforation following endoscopic sphincterotomy of papilla of Vater].
BACKGROUND
Endoscopic sphincterotomy (ES) is an established procedure in treatment of diseases of the biliary tract; management of serious complications such as duodenal perforation remains controversial. Because mortality is high if sepsis is inadequately treated by no use of operative means, many surgeons advocate routine operative repair and drainage upon diagnosis. In surveys of large experiences, however, the majority patients initially were treated non-surgically, and the majority recovered.


OBJECTIVE
To evaluate our experience with non-surgical management in patients with duodenal perforation after ES.


METHODS
Retrospective chart review from January 1991 to December 2000 identified 12 instances of duodenal perforation. We reviewed endoscopic cholangiopancreatography (ERCP) findings, diagnostic methods, time to diagnosis, methods of management, length of patient stay, and outcome.


RESULTS
Twelve patients with diagnosis of choledocholithiasis (5) papillary stenoses (4) and carcinoma of pancreas (3) had duodenal perforation among 1,510 ES performed (0.79%). In all cases during ES, retroperitoneal air on fluoroscopic examinations was observed and diagnosis was made. One patient was managed initially by surgery and death occurred due to pulmonary complications. Eleven patients were treated conservatively with nasogastric aspiration, none by mouth intravenous fluids, antibiotics, and somatostatin analog without mortality. Median length of stay was 6.7 days.


CONCLUSIONS
Duodenal perforation after ES may be treated conservatively with success if identified during ES or early stage. Early diagnosis of duodenal perforation is essential for optimum outcome.
Güitrón-Cantú
Alfredo
A
Departamento de Endoscopia Digestiva, Hospital de Especialidades No. 71, Instituto Mexicano del Seguro Social, Blvd. Revolución y Calle 26, C.P. 27000 Torreón, Coahuila.
Adalid-Martínez
Raúl
R
Gutiérrez-Bermúdez
José A
JA
D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004378:Duodenal Diseases / Q000601:surgery*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies