Case Report: Gallbladder perforation after endoscopic retrograde cholangiopancreatography-a rare complication

Endoscopic retrograde cholangiopancreatography (ERCP) is a state-of-the-art diagnostic and therapeutic procedure for various pancreatic and biliary problems. In spite of the well-established safety of the procedure, there is still a risk of complications such as pancreatitis, cholangitis, bleeding and perforation. Gallbladder perforation has rarely been reported in association with ERCP.

A 58-year-old male with pancreatic cancer was admitted for jaundice and underwent ERCP with fully covered self-expanding metal stent (FCSEMS) placement for obstructive jaundice, with significant postoperative bilirubin reduction. On the 10th postoperative day, the patient developed fever and severe right upper quadrant abdominal pain. Enhanced computed tomography (CT) of the upper abdomen confirmed gallbladder perforation complicated by perigallbladder abscess formation. Ultrasound-guided percutaneous abscess drainage and repeat ERCP with replacement of the common bile duct plastic stents ultimately resolved this complication, underscoring the critical importance of timely diagnosis and targeted intervention.

We report the first case of gallbladder perforation after ERCP in a patient with pancreatic cancer. Advanced imaging modalities, such as enhanced CT, play a crucial role in identifying ERCP complications. In this case, timely intervention through ultrasound-guided cholecystic abscess drainage and replacement with the plastic stents achieved successful resolution.

This case underscores the rarity and clinical significance of ERCP-related gallbladder perforation, emphasizing the need for enhanced post-procedure scrutiny, especially in patients with relevant symptoms.