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Updated: Aug 24, 2026
Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess
Published on: March 15, 2024
[Posterior laparostomy for retroperitoneal infections caused by periampullar endoscopic procedures: an old technique
Giovanni Battista Doglietto1, Fabio Pacelli, Valerio Papa
1Dipartimento di Scienze Chirurgiche, Unità Operativa di Chirurgia Digestiva, Università Cattolica del Sacro Cuore, Via della Mendola, 47, 00135 Roma.
Abstract:
Duodenal perforations occur in 0.4-1% of endoscopic manoeuvres. In cases of periampullary injury, the best therapeutic approach is still controversial. Generally, the first treatment will be conservative, but in some patients large retroperitoneal infections requiring surgical treatment develop. Six patients, referred to our unit for extensive retroperitoneal collections and unstable septic conditions as a consequence of periampullary duodenal perforation during ERCP, were treated by right posterior laparostomy with twelfth rib resection. The septic process was treated efficaciously by the open posterior approach that favoured the spontaneous closure of the duodenal leak after a mean period of 14.5 +/- 5.2 days. No hospital deaths or major complications were recorded. Late incisional hernia developed in one case. The technique of posterior laparostomy with twelfth rib resection permits adequate debridement and drainage of both the upper and lower parts of the retroperitoneal space involved in infection after periampullary duodenal perforations. The good control of both the retroperitoneal septic process and the duodenal secretions facilitates the spontaneous closure of the duodenal leak, thus avoiding the risk of more complex and dangerous procedures.
Insights
Right posterior laparostomy effectively treated severe retroperitoneal infections from endoscopic retrograde cholangiopancreatography (ERCP) duodenal perforations. This approach facilitated spontaneous duodenal leak closure, avoiding complex surgery.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Abdominal Surgery
Background:
- Duodenal perforations complicate 0.4-1% of endoscopic procedures.
- Periampullary duodenal injuries present therapeutic challenges, with conservative management sometimes leading to severe retroperitoneal infections.
Purpose of the Study:
- To evaluate the efficacy of right posterior laparostomy with twelfth rib resection for managing extensive retroperitoneal collections and sepsis secondary to periampullary duodenal perforation.
Main Methods:
- Six patients with severe retroperitoneal infections post-ERCP duodenal perforation underwent right posterior laparostomy with twelfth rib resection.
- The surgical approach focused on debridement, drainage, and management of duodenal secretions.
Main Results:
- The posterior laparostomy effectively controlled sepsis in all patients.
- Spontaneous closure of the duodenal leak occurred in a mean of 14.5 days.
- No hospital deaths or major complications were observed; one patient developed a late incisional hernia.
Conclusions:
- Right posterior laparostomy with twelfth rib resection is a safe and effective treatment for severe retroperitoneal infections following periampullary duodenal perforations.
- This technique allows for adequate retroperitoneal space management, promoting spontaneous duodenal leak closure and potentially avoiding more invasive procedures.
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