Posterior laparostomy through the bed of the 12th rib to drain retroperitoneal infection after endoscopic sphincterotomy.
BACKGROUND
Duodenal perforation occurs in 0.4-1 per cent of endoscopic procedures. The best therapeutic approach for periampullary injury is controversial; initially the treatment is generally conservative, but sometimes large retroperitoneal infections develop that require surgery.


METHODS
Six patients with an extensive retroperitoneal collection and unstable sepsis as a consequence of periampullary duodenal perforation sustained during endoscopic retrograde cholangiopancreatography were treated by right posterior laparostomy through the bed of the 12th rib.


RESULTS
The sepsis was managed effectively by an open posterior approach, resulting in spontaneous closure of the duodenal leak after a mean(s.d.) of 14.5(5.2) days. No hospital death or major complication was recorded. Late incisional hernia developed in one patient.


CONCLUSIONS
The technique of posterior laparostomy through the bed of the 12th rib provided adequate debridement and drainage of upper and lower parts of the retroperitoneal space involved by infection following periampullary duodenal perforation. Good control of retroperitoneal sepsis and duodenal secretions resulted in spontaneous closure of the duodenal leak, avoiding the need for more complex intra-abdominal procedures.
Doglietto
G B
GB
Digestive Surgery Unit, Department of Surgical Sciences, Catholic University, School of Medicine, Rome, Italy.
Pacelli
F
F
Caprino
P
P
Alfieri
S
S
Tortorelli
A P
AP
Mutignani
M
M
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000379:methods*; D012187:Retroperitoneal Space; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods