OGBN P47 Isolated Pneumoperitoneum following ERCP

Abstract

Abstract Background An 84-year-old man underwent a difficult ERCP following biliary leak after laparoscopic converted to open cholecystectomy for acute cholecystitis. Postoperative scan was suggestive of bile leak from Cystic Duct stump and an ERCP-stenting had been requested to treat the problem. He needed urgent decompression for extensive pneumoperitoneum causing acute ventilatory dysfunction during the procedure. Post procedure CT showed pneumoperitoneum and pneumobilia suggesting air leak through Cystic Duct Stump. Methods The patient had been admitted for acute cholecystitis and had undergone treatment as an inpatient. An urgent abdominal decompression with a Veress needle after completing the procedure had resolved the acute respiratory distress. He needed a short stay in the intensive care after the ERCP before being safely stepped down to the wards. Records of the rare event was collected retrospectively from the hospital electronic patient record system. Results The patient recovered after continued monitoring and support in the Intensive Care. He needed transient respiratory support and treatment for lung collapse. The CT scan ruled out any duodenal injury - the initial suspected reason for the acute deterioration. The presumed cause of the pneumoperitoneum was air leak from an open Cystic Duct stump following canulation of the common bile duct. Conclusions Pneumoperitoneum after ERCP is usually secondary to duodenal injury. Our patient had no evidence of Free pneumoperitoneum causing respiratory compromise at ERCP - this is extremely rare. The patient was monitored till discharge for any sign of hollow viscus re-perforation Pneumoperitoneum due to air leak from Cystic Duct stump has not been reported before.