Duodenal perforation post-ERCP: Diagnostically and therapeutic management

Abstract

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.