[Duodenal perforation post-ERCP: diagnostically and therapeutic management].
OBJECTIVE
Author's experience with periduodenal perforation after ERCP and there systematic approach is presented.


METHODS
A retrospective study of 6 instances of duodenal perforation related to endoscopic retrograde cholangiopancreatography. The study follows these parameters: type of perforations, clinical presentation, diagnostic methods, time to diagnosis, methods of management, surgical procedures, length of stay, mortality and morbidity.


RESULTS
Traditionally duodenal perforation after ERCP has been managed surgically; however in last decade management has been shifted to a more selective approach, but some authors promotes non surgical routine management: the reported death rate of medical treatment is high as 50%. In our experience an aggressive diagnostically and therapeutically management may reduce mortality. The decision to manage patients without surgery is a dynamic one and should undergo frequent reevaluation whenever the clinical circumstances demonstrate even the slightest untoward development.


CONCLUSIONS
A selective management scheme and an aggressive but selective surgical approach may influence overall mortality.
Fattori
Luca
L
Ospedale S. Gerardo dei Tintori, Divisione di Chirurgia 3a, Monza.
Nespoli
Luca
L
Ardito
Antonella
A
Germini
Alessandro
A
Nespoli
Angelo
A
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004386:Duodenum / Q000293:injuries*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy