title: Laparoscopic management of a retroperitoneal duodenal perforation following ERCP for periampullary cancer.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP) is a fairly common procedure being performed in several centers worldwide. Although it is proven to be efficient and relatively safe, complications do occur (1.8%). We present a patient with ERCP-induced retroperitoneal perforation of the duodenum treated laparoscopically at our institution.
  
  
  METHODS
  The patient is a 60-year-old female who underwent ERCP for obstructive jaundice due to periampullary carcinoma, during which the perforation occurred. Laparoscopy was performed 5 hours later and the perforation sutured primarily.
  
  
  RESULTS
  The operating time was 125 minutes. On the fourth postoperative day, the patient developed a retroperitoneal collection, confirmed by computed tomographic scan. Re-look laparoscopy was performed and the fluid drained. She recovered completely and was discharged on the eighth postoperative day.
  
  
  CONCLUSIONS
  Duodenal perforation following ERCP is rare, with an incidence of 1.8%. Both surgical and non-surgical management have been reported, each with its specific indications. Our patient needed surgery, because the perforation was large and a retroperitoneal collection was present. Laparotomy is the preferred approach, though now laparoscopy is a viable and effective alternative, because it provides the benefits of minimal access, such as reduced pain and early ambulation.
authors.affiliation: GEM Hospital & Postgraduate Institute, Coimbatore, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Priyadarshan Anand
authors.initials: PA
authors.lastname: Jategaonkar
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.forename: Natesan Vijay
authors.initials: NV
authors.lastname: Anand
authors.forename: Palaniswamy
authors.initials: P
authors.lastname: Senthilnathan
mesh_terms: D014670:Ampulla of Vater; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis; D004386:Duodenum / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012187:Retroperitoneal Space