Abstract
Background and Aim: After successful medical management of a patient with a clinical picture suggestive of post-sphincterotomy duodenal perforation, in which a computerized axial tomography (CAT) scan of the abdomen revealed the presence of subcutaneous emphysema and retroperitoneal air, concern arose as to the frequency of pneumoretroperitoneum following endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ES) and if any procedure dependent factors were associated with this problem. Aim: To assess the frequency and clinical significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Methods: Fifty consecutive patients, who had undergone ERCP with sphincterotomy, were submitted to abdominal CT examinations within 24 hours after completion of the procedure. One patient was with a large precut, but a failed ERCP was also included. The ERCP findings were unknown to the radiologist. Results: Seven (14%) of 50 patients showed CT findings of retroperitoneal air. All of them had uneventful post-procedural recovery. No clinical or laboratory abnormality was found in this group of patients. The presence of retroperitoneal air was not associated to the variables: precut, biliopancreatic disease type, endoscopic sphincterotomy length, additional endoscopic procedure (balloon exploration, gallstone extraction, stent insertion) or procedure duration. Conclusion: After ERCP with ES, retroperitoneal air is frequently found. In the absence of physical symptoms, retroperitoneal air is not clinically relevant and does not require specific treatment.
Highlights
In the hands of an expert, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) are associated with high rates of success and few complications, most of which can be treated conservatively [1]
All the patients tolerated the procedure well and no complications occurred during endoscopy
computerized axial tomography (CAT) scans revealed the presence of retroperitoneal air in only seven (14.6%)
Summary
In the hands of an expert, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) are associated with high rates of success and few complications, most of which can be treated conservatively [1]. Stapfel [6] classified duodenal perforation, in descending order of severity, into four types, being type IV the finding of retroperitoneal air This author did not refer to the incidence or clinical significance of such situations. After successful medical management of a patient with a clinical picture suggestive of post-sphincterotomy duodenal perforation, in which a computerized axial tomography (CAT) scan of the abdomen revealed the presence of subcutaneous emphysema and retroperitoneal air, concern arose as to the frequency of pneumoretroperitoneum following endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (ES) and if any procedure dependent factors were associated with this problem. In the absence of physical symptoms, retroperitoneal air is not clinically relevant and does not require specific treatment
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