Complications of endoscopic retrograde sphincterotomy: computed tomographic evaluation

Although the reported complication rate of endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is low, patients often experience abdominal pain postprocedure. When pain persists, or fever and leukocytosis develop, a procedure-related complication should be suspected. The authors reviewed a series of 36 patients referred to computed tomography (CT) for evaluation of possible complications following ERCP with sphincterotomy. Initial CT scans were obtained within 24 h in 19 patients, and during the second to seventh day in the remainder. Complications detected by CT included acute pancreatitis (23), duodenal perforation (11), retroperitoneal dissection of air (4), pneumoperitoneum (4), and development of retroperitoneal abscess (4). Eight patients had normal CT scans except for air and contrast material in the biliary tree. The severity and extent of injury were readily assessed by CT, and response to therapy effectively monitored by serial CT examinations. Thirty-one cases (31 of 36) were successfully managed conservatively with antibiotics, intravenous hydration, and restriction of oral intake. Four patients required surgical intervention for drainage of a retroperitoneal abscess (3) or a pseudocyst (1). A fifth patient required intensive care resuscitation for septic shock. We conclude that CT is the study of choice for evaluating the patient with suspected complication following ERCP and sphincterotomy.