Strategia diagnostico-terapeutica nelle complicanze perforative post-colangiopancreatografia retrograda endoscopica (ERCP)

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COD: 193-194 Categorie: ,

Luca Fattori, Luca Nespoli, Antonella Ardito, Alessandro Germini, Angelo Nespoli

Ann. Ital. Chir., 2007; 78: 193-194

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OBJECTIVE: Author’s experience with periduodenal perforation after ERCP and there systematic approach is presented.
METHODS: A retrospective study of 6 instances of duodenal perforation related to endoscopic retrograde cholangiopancreatography.
The study follows these parameters: type of perforations, clinical presentation, diagnostic methods, time to diagnosis,
methods of management, surgical procedures, length of stay, mortality and morbidity.
RESULTS: Traditionally duodenal perforation after ERCP has been managed surgically; however in last decade management
has been shifted to a more selective approach, but some authors promotes non surgical routine management : the
reported death rate of medical treatment is high as 50%.
In our experience an aggressive diagnostically and therapeutically management may reduce mortality.
The decision to manage patients without surgery is a dynamic one and should undergo frequent reevaluation whenever
the clinical circumstances demonstrate even the slightest untoward development.
CONCLUSION: A selective management scheme and an aggressive but selective surgical approach may influence overall
mortality.

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