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KMID : 0371320070720030210
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Journal of the Korean Surgical Society
2007 Volume.72 No. 3 p.210 ~ p.215
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Management for Duodenal Perforation Caused by Endoscopic Retrograde Cholangiopancreatography (ERCP)
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Cho Min-Soo
Park Dong-Eun
Chae Kwon-Mook
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Abstract
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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 24hours. 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. (J Korean Surg Soc 2007;72:210- 215)
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KEYWORD
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ERCP, Perforation, Treatment
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