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Post ERCP Duodenal Perforation

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Dr RK Wadhwa    05 December 2018

  • Factors associated with an increased risk of post-endoscopic retrograde cholangiopancreatography (post-ECRP) perforation are dilated common bile duct; dysfunction of the sphincter of Oddi; prolonged duration of the procedure; biliary stricture dilatation; and performance of sphincterectomy.
  • Free abdominal perforation – type I is usually, immediately identified, whereas retroduodenal perforation – type II, is recognized by radiographic evidence of air or contrast.
  • A suspected duodenal perforation should be confirmed with CT abdomen with oral contrast.
  • In the case, duodenal perforation is not confirmed, medical therapy should be commenced. If confirmed, duodenal perforation should be classified according to the presumed mechanical injury.
  • For type I duodenal perforation which has been diagnosed within 12 hours of the procedure, surgical repair is recommended. However, if the perforation has been recognized later, the need for duodenal exclusion should be evaluated along with the surgical repair.
  • For type II duodenal perforation, conservative management is suggested. Medical therapy should be initiated in such cases and a multidisciplinary approach with hepatobiliary surgeons should be opted for.
  • In case this strategy fails, duodenal exclusion may be required along with surgical repair.

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