Management for Duodenal Perforation Caused by Endoscopic Retrograde Cholangiopancreatography (ERCP).
- Author:
Min Soo CHO
1
;
Dong Eun PARK
;
Kwon Mook CHAE
Author Information
1. Department of Surgery, Wonkwang University College of Medicine, Iksan, Korea. chaekm@wonkwang.ac.kr
- Publication Type:Original Article
- Keywords:
ERCP;
Perforation;
Treatment
- MeSH:
Cholangiopancreatography, Endoscopic Retrograde*;
Delayed Diagnosis;
Diagnosis;
Drainage;
Fatal Outcome;
Humans;
Length of Stay;
Reoperation;
Retrospective Studies;
Sphincterotomy, Transhepatic;
Tomography, X-Ray Computed
- From:Journal of the Korean Surgical Society
2007;72(3):210-215
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Although duodenal perforation following ERCP is very rare compared to other complications, it can result in a fatal outcome. To find the most effective treatment strategy, the cases experienced at our hospital were reviewed and analyzed. METHODS: A retrospective chart review, conducted at our hospital between December 1994 and April 2006, identified 15 periduodenal perforation cases related to ERCP; a rate of 0.53%. The following parameters were reviewed: clinical presentation of perforation, diagnostic methods, time to diagnosis and operation, method of management, length of stay and outcome. RESULTS: Fourteen patients were managed by surgery and one conservatively. Eleven patients were cured without complications, but four suffered from severe complications, and required several re-operations. Two patients (50%) of the re-operated group died. The mean time to surgery was longer in the re-operated than non-re-operated group (34.3+/-12.4 hours vs. 17.2+/-21.7 hours). The causes for the reoperation were an anastomosis blowout in the duodenotomy for transduodenal sphincteroplasty in 3 and duodenal perforation at the site of transduodenal sphincteroplasty in the remaining patient. All re-operated cases had large retroperitoneal fluid collection, as seen on CT scanning, and had been operated on by inexperienced surgeons. CONCLUSION: The early detection is important for the treatment of a duodenal perforation following ERCP. If surgical treatment is needed, it must be performed within 24 hours. Although the type of surgical procedure will depend on the surgeon's preference, a less invasive procedure, such as simple closure & drainage, will be adequate in cases with a delayed diagnosis, a septic condition or an inexperienced surgeon.
