Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1%) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract. Conclusions This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patient's wellbeing.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. e incidence of pneumoperitoneum post-ERCP is rarely seen (
Iatrogenic post-ERCP duodenal perforation is regarded as a common complication, while intrahepatic bile duct ruptures are rare and have been associated in case reports with surgically damaged liver tissue, liver metastasis, and abscesses [5, 6]
The duodenum, pancreas, and retroperitoneum were found to be intact, and the ruptured healthy hepatic bile duct was detected. It is curious though how no aberrant subcapsular hepatic bile duct or any other possible anatomic anomaly of the liver was found neither on MRCP, ERCP, or cholangiography. All this implies that our case report is the first in literature to describe a novel case of biliary peritonitis postERCP
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) has, in its more than 50 years of clinical practice, been proven to be a relatively safe procedure in the diagnosis and treatment of biliary and pancreatic diseases [1]. e main advantage of ERCP above its alternative, hepatobiliary surgery, is lower morbidity and mortality [2]. E most common complications of ERCP are infections such as cholangitis and pancreatitis, bleeding, or intestinal perforation [3]. Iatrogenic post-ERCP duodenal perforation is regarded as a common complication, while intrahepatic bile duct ruptures are rare and have been associated in case reports with surgically damaged liver tissue, liver metastasis, and abscesses [5, 6]. The radiologist found the biliary peritonitis to be a consequence of duodenal perforation; the surgical team intraoperatively identified a ruptured, but otherwise, healthy subcapsular hepatic bile duct as the cause of the biliary peritonitis. A literature review was performed for similar cases, and no case of healthy hepatic bile duct rupture causing biliary peritonitis after ERCP has been reported. Written informed consent has been given by the patient. e following case report has been reported in line with the SCARE criteria [7]
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