A rare post-ERCP complication: a case report of pneumoperitoneum, pneumo-retroperitoneum, and surgical emphysema following unsuccessful ERCP.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure performed to diagnose and treat pancreatic and biliary diseases. In about 5%-10% of patients it causes adverse events. Pancreatitis is the most common complication; duodenal perforation, hemorrhage and cholangitis are less frequent. Duodenal perforation is an infrequent complication of ERCP, usually associated with sphincterotomy; it may be asymptomatic, passing un-noticed, or causing abdominal symptoms. The management of symptomatic perforation should be initially conservative including bowel rest, nasogastric suction, hydration and antibiotics. These patients must be carefully observed, because 20%-40% may require surgical treatment. Surgery is recommended in patients with persistent biliary obstruction, cholangitis, a septic status and those whose symptoms do not improve after a brief period of non-operative management.Here we present a case of post-ERCP pneumoperitoneum, pneumoretroperitoneum, and surgical emphysema treated successfully with operative intervention but with non-visualized perforation.