Duodenal perforation in course of endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy.

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Vincenzo Neri, Antonio Ambrosi, Alberto Fersini, Tiziano Pio Valentino

Ann. Ital. Chir., 2006; 77: 161-164

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AIM OF THE STUDY: To define the therapeutic program for the treatment of perforative complication of the duodenum
in course of endoscopic retrograde cholangio-pancreatography (ERCP) with endoscopic sphincterotomy (ES).
MATERIAL OF THE STUDY: In the period from 1997 to 2003, 5 duodenal perforations occurred during 101 ERCP/ES
(4.95%), executed in two digestive endoscopic centres. Three patients were operated in emergency (duodenostomy, external
biliary drainage, gastric-enteric-anastomosis). The other two were treated conservatively with nasal-duodenal drainage
in aspiration.
RESULTS: The postoperative complications were modest. Anyway there were no signs of sepsis nor of retro/endoperitoneal
purulent collections. Biliary drainage, upon radiologic control, and duodenostomy, were removed within the 4th postoperative
week. There was no mortality.
DISCUSSION: Immediate surgery was performed when the presence of the radio-contrast in the retroperitoneum was persistent.
In case of retroperitoneal and/or small perforations, we preferred early oral intake, trusting on the diversion of
the biliary and duodenal secretions. The pointform perforations, without persistence of radio-contrast, were treated by the
conservative approach.
CONCLUSION: The proposed treatment of duodenal perforation in course of ERCP was efficacious and safe, and avoided
in our experience every risk of septic evolution.

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