[Surgical tactics in treatment of duodenal injuries after endoscopic sphincterotomy]

The procedure in case of injury of the duodenum as a complication of endoscopic sphincterotomy remains controversial. We have studied all the cases of duodenal injury after endoscopic sphincterotomy during last 5 years to indicate the best strategy of surgical treatment. We observed 10 cases of duodenal perforations following 464 endoscopic sphincterotomies. Other 4 patients came from different hospitals. Six patients were managed with nonoperative treatment (group I), four patients were operated on right after the diagnosis (group II), and other four patients were initially managed with nonoperative treatment and then were operated at least 3 days after the complications occurred (group III). All the patients treated nonsurgically recovered. All the patients from group III and one from group II died, as a result of duodenal fistula and sepsis. Spontaneous recovery was observed in those cases in which gradual improvement appeared during first 24 hours. Operation should be undertaken when the symptoms are quickly increasing and primary nonsurgical treatment is not satisfied. The operations delayed for more than 3 days give poor results.