title: Surgical outcome of patients with perforation after endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  The most important criterion in the management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations is the delineation of the injury pattern. The aim of the present study was to evaluate in a retrospective manner the patients who undergo surgery due to ERCP-related perforations.
  
  
  METHODS
  Between January 2006 and December 2010, a total of 9209 ERCPs were performed at Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey. From these, perforation was diagnosed in 52 patients (0.56%). Twenty-four patients (46.2%) underwent surgery. Patients were evaluated according to age, gender, ERCP indication, comorbid disease, the time between diagnosis and perforation, the time between ERCP and surgical intervention, radiological and clinical signs, localization of the perforation, surgical procedure, hospitalization period, and postoperative outcome.
  
  
  RESULTS
  Twenty-four patients underwent surgery. Thirteen patients (54.1%) had lateral duodenal wall perforation, 4 patients (16.7%) had perforation in the afferent loop (these patients had Billroth-II gastroenterostomy at ERCP admission), 2 patients (8.3%) had bile duct perforation, and 1 patient (4.1%) had esophageal perforation. In 4 patients (16.7%), the localization of the perforation could not be found. Nine patients (37.5%) died in the postoperative period. Six patients had lateral duodenal wall perforation, 2 patients had afferent loop perforation, and one patient had esophagus perforation. Three patients died of nonsurgical reasons (myocardial infarction, serebrovascular occlusion, and cardiac dysrhythmia).
  
  
  CONCLUSIONS
  Duodenal wall perforations have a serious fatal outcome even if early surgical intervention is performed. In contrast to duodenal wall injuries, perivaterian and choledochal injuries have a better outcome.
authors.affiliation: Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Ercan
authors.forename: Erdal Birol
authors.initials: EB
authors.lastname: Bostanci
authors.forename: Tahsin
authors.initials: T
authors.lastname: Dalgic
authors.forename: Kerem
authors.initials: K
authors.lastname: Karaman
authors.forename: Yusuf Bayram
authors.initials: YB
authors.lastname: Ozogul
authors.forename: Ilter
authors.initials: I
authors.lastname: Ozer
authors.forename: Murat
authors.initials: M
authors.lastname: Ulas
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Musa
authors.initials: M
authors.lastname: Akoglu
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000401:mortality; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome