title: Duodenal perforation in course of endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy. Therapeutic considerations.
abstract: OBJECTIVE
  To define the therapeutic program for the treatment of perforative complication of the duodenum in course of endoscopic retrograde cholangio-pancreatography (ERCP) with endoscopic sphincterotomy (ES). MATERIAL OF THE STUDY: In the period from 1997 to 2003, 5 duodenal perforations occurred during 101 ERCP/ES (4.95%), executed in two digestive endoscopic centres. Three patients were operated in emergency (duodenostomy, external biliary drainage, gastric-enteric-anastomosis). The other two were treated conservatively with nasal-duodenal drainage in aspiration.
  
  
  RESULTS
  The postoperative complications were modest. Anyway there were no signs of sepsis nor of retro/endoperitoneal purulent collections. Biliary drainage, upon radiologic control, and duodenostomy, were removed within the 4th postoperative week. There was no mortality.
  
  
  CONCLUSIONS
  Immediate surgery was performed when the presence of the radio-contrast in the retroperitoneum was persistent. In case of retroperitoneal and/or small perforations, we preferred early oral intake, trusting on the diversion of the biliary and duodenal secretions. The point form perforations, without persistence of radio-contrast, were treated by the conservative approach.
  
  
  CONCLUSIONS
  The proposed treatment of duodenal perforation in course of ERCP was efficacious and safe, and avoided in our experience every risk of septic evolution.
authors.affiliation: University of Foggia, Department of Surgical Sciences, Division of General Surgery, Polyclinic "Ospedali Riuniti", Foggia, Italy. v.neri@unifg.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Neri
authors.forename: Antonio
authors.initials: A
authors.lastname: Ambrosi
authors.forename: Alberto
authors.initials: A
authors.lastname: Fersini
authors.forename: Tiziano Pio
authors.initials: TP
authors.lastname: Valentino
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004322:Drainage; D004385:Duodenostomy; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D004630:Emergencies; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery* / Q000628:therapy; D011182:Postoperative Care; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed