title: [Duodenal perforation due to an endoscopic biliary prosthesis].
abstract: Endoscopic biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP) is a widely accepted therapeutic option in malignant biliary obstructions. However, the procedure is not free of complications. Perforation is one possible complication although it is much less frequent (less than 1%) than pancreatitis (5.4%) or hemorrhage (2%). We present 2 cases of duodenal perforation after placement of a biliary prosthesis through ERCP. Both patients had extensive hilar cholangiocarcinoma. Onset of symptoms of perforation occurred a few hours after placement of the prosthesis and the diagnosis was confirmed by computed tomography and laparotomy. We believe that the mechanism through which perforation occurred was proximal adhesion of the prosthesis to the tumor. This increased the intensity of distal trauma produced by the intraduodenal segment, preventing adaptation of the prosthesis to intestinal peristalsis. A good preventive measure would consist of correctly adjusting the length of the prosthesis in relation to the proximal end of the biliary stenosis.
authors.affiliation: Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain. loladig@hotmail.com
authors.forename: M D
authors.initials: MD
authors.lastname: Sánchez-Tembleque
authors.forename: A
authors.initials: A
authors.lastname: Naranjo Rodríguez
authors.forename: R
authors.initials: R
authors.lastname: Ruiz Morales
authors.forename: A J
authors.initials: AJ
authors.lastname: Hervás Molina
authors.forename: B
authors.initials: B
authors.lastname: Calero Ayala
authors.forename: J F
authors.initials: JF
authors.lastname: de Dios Vega
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*