title: Endoscopic fibrin sealant closure of duodenal perforation after endoscopic retrograde cholangiopancreatography.
abstract: Traditionally, perivaterian duodenal perforation can be managed conservatively or surgically. If a large volume of leakage results in fluid collection in the retroperitoneum, surgery may be necessary. Our case met the surgical indication for perivaterian duodenal perforation after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic papillary balloon dilatation. The patient developed a retroperitoneal abscess after the procedures, and a perivaterian perforation was suggested on computed tomography (CT). CT-guided abscess drainage was performed immediately. We unsuccessfully attempted to close the perforation with hemoclips initially. Subsequently, we used fibrin sealant (Tisseel) injection to occlude the perforation. Fibrin sealant injections have been previously used during endoscopy for wound closure and fistula repair. Based on our report, fibrin sealant injection can be considered as an alternative method for the treatment of ERCP-related type II perforations.
authors.affiliation: Hsin-Yeh Yang, Jui-Hao Chen, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan.
authors.forename: Hsin-Yeh
authors.initials: HY
authors.lastname: Yang
authors.affiliation: Hsin-Yeh Yang, Jui-Hao Chen, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan.
authors.forename: Jui-Hao
authors.initials: JH
authors.lastname: Chen
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation; D004386:Duodenum / Q000000981:diagnostic imaging / Q000293:injuries*; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Endoscopic retrograde cholangiopancreatography; Perivaterian duodenal perforation; Retroperitoneal abscess