Case series: pneumoretroperitoneum secondary to duodenal perforation after endoscopic retrograde cholangiopancreatography.

68 J can chir, Vol. 52, N 1, février 2009 © 2009 Association médicale canadienne E ndoscopic 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, but duodenal perforation, hemorrhage and cholangitis are less frequent. Duodenal perforation is an infrequent complication of ERCP, usually associated with sphincterotomy. Clinical manifestations are similar to those that appear in pancreatitis (i.e., abdominal pain, fever and leukocytosis). Computed tomography (CT) is the best method for the diagnosis of duodenal perforation, detecting retroperitoneal air or liquid. Management of this complication must be initially conservative, but if the patient does not improve after a brief period, surgical intervention is mandatory. Duodenal perforation is associated with a high mortality rate, therefore early diagnosis is important. We present 4 cases of pneumoretroperitoneum after ERCP.