title: Duodenal perforations after endoscopic retrograde cholangiopancreatography: experience and management.
abstract: OBJECTIVE
  The aim of this study was to summary the experiences and lessons from periduodenal perforations related to endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST).
  
  
  METHODS
  A retrospective review from 2004 to 2007 identified 9 patients (0.37%) of periduodenal perforation related to ERCP/EST. Charts were reviewed for the following parameters: clinical presentation of patients, ERCP findings, diagnostic methods, treatment (surgical or conservative procedures), complications, and outcome.
  
  
  RESULTS
  Nine patients who had periampullary perforations received ERCP/EST for common bile duct stones. Cannulation was considered difficult in 7 of 9 patients, and the precut technique was used. The diagnosis was made due to subcutaneous emphysema or peritonitis, and 3 patients received emergent operations (e.g., external biliary or retroperitoneal drainage), and 1 patient had a reoperation for a retroperitoneal sealed abscess. Their median length of hospital stay was 50 days. The other 6 were treated conservatively with nasal-duodenal and nasal-biliary drainage. Their median length of hospital stay was 13 days. There was no mortality.
  
  
  CONCLUSIONS
  The precut technical may be a risk factor of duodenal perforation. Early diagnosis of duodenal perforation is essential for an optimum outcome, and subcutaneous emphysema may be a sensitive sign. Although the management of perforation after ERCP/EST is still controversial, a selective management is proposed, based on the features of classification type. Nevertheless, duodenal and biliary drainage is essential in both surgical and conservative therapy.
authors.affiliation: Department of General Surgery, Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Zhihai
authors.initials: Z
authors.lastname: Mao
authors.forename: Qianlin
authors.initials: Q
authors.lastname: Zhu
authors.forename: Weize
authors.initials: W
authors.lastname: Wu
authors.forename: Mingliang
authors.initials: M
authors.lastname: Wang
authors.forename: Jianwen
authors.initials: J
authors.lastname: Li
authors.forename: Aiguo
authors.initials: A
authors.lastname: Lu
authors.forename: Yanjun
authors.initials: Y
authors.lastname: Sun
authors.forename: Minhua
authors.initials: M
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004386:Duodenum / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed