Life-threatening duodenal perforation complicating endoscopic retrograde cholangiopanceatography: A case series

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure for biliary and pancreatic diseases. It is associated with low rate of complications. However, some complications as duodenal perforation can be fatal.

852 patients underwent ERCP at our hospital, six patients had a duodenal perforation (0.7 %). All patients were admitted with clinical and biochemical findings of obstructive jaundice without acute cholangitis. All patients had biliary tree dilatation confirmed on abdominal ultrasound scan and/or magnetic resonance cholangiopanceatography. Two patients were initially managed surgically, one of them died due to multi-organ failure. The other four patients were initially treated conservatively; two of them failed conservative management with one death due to sepsis, other two patients recovered without complications. The overall mortality rate was (33.3 %).

Multiple attempts of CBD cannulation and pre-cut sphincterotomy may increase the possibility of duodenal perforation. In the presence of clinical suspicion of perforation, an early radiological imaging is helpful for an early intervention.

A high index of suspicion is essential for early diagnosis and intervention to improve the clinical outcome. In difficult ERCP, performing a post-procedural fluoroscopy study with contrast injection is essential.