Duodenal perforation post-ERCP: diagnostically and therapeutic management
Fattori, L.; Nespoli, L.; Ardito, A.; Germini, A.; Nespoli, A.
Annali Italiani di Chirurgia 78(3): 193-194
2007
ISSN/ISBN: 0003-469X PMID: 17722492 Document Number: 613395
Author's experience with periduodenal perforation after ERCP and there systematic approach is presented. A retrospective study of 6 instances of duodenal perforation related to endoscopic retrograde cholangiopancreatography. The study follows these parameters: type of perforations, clinical presentation, diagnostic methods, time to diagnosis, methods of management, surgical procedures, length of stay, mortality and morbidity. Traditionally duodenal perforation after ERCP has been managed surgically; however in last decade management has been shifted to a more selective approach, but some authors promotes non surgical routine management: the reported death rate of medical treatment is high as 50%. In our experience an aggressive diagnostically and therapeutically management may reduce mortality. The decision to manage patients without surgery is a dynamic one and should undergo frequent reevaluation whenever the clinical circumstances demonstrate even the slightest untoward development. A selective management scheme and an aggressive but selective surgical approach may influence overall mortality.