Endoscopic Retrograde Cholangiopancreatography Scope‑induced Duodenojejunal Flexure Perforation: The World’s First Case

ABSTRACT

Duodenojejunal (DJ) flexure perforation is very rare. DJ flexure perforation following endoscopic retrograde cholangiopancreatography (ERCP) has not be documented till date. They are associated with significant morbidity and mortality. We present an ERCP‑induced DJ flexure perforation which has been treated with primary closure in two layers at our institution. To the best of our knowledge, this is the world’s first case. Such site of ERCP‑induced perforation has not been reported in literature till date. A 75‑year‑old female patient underwent repeated ERCP for obstructive jaundice. There was perforation during the third ERCP while removing the larger stone. Emergency laparotomy was performed with primary closure of perforation in two layers. ERCP‑induced DJ flexure perforation has not yet been documented. It is potentially life‑threatening. Early recognition may lead to a better prognosis through earlier intervention.

KEYWORDS:

Duodenojejunal flexure perforation - endoscopic retrograde cholangiopancreatography - management

• REFERENCES

• 1 Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ. et al Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-18
• 2 Enns R, Eloubeidi MA, Mergener K, Jowell PS, Branch MS, Pappas TM. et al ERCP-related perforations: Risk factors and management. Endoscopy 2002; 34: 293-8
• 3 Stapfer M, Selby RR, Stain SC, Katkhouda N, Parekh D, Jabbour N. et al Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232: 191-8
• 4 Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC. et al Complications of ERCP. Gastrointest Endosc 2003; 57: 633-8
• 5 Kaneko T, Akamatsu T, Shimodaira K, Ueno T, Gotoh A, Mukawa K. et al Nonsurgical treatment of duodenal perforation by endoscopic repair using a clipping device. Gastrointest Endosc 1999; 50: 410-3
• 6 Cotton PB. Analysis of 59 ERCP lawsuits; mainly about indications. Gastrointest Endosc 2006; 63: 378-82
• 7 Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. JOP 2012; 13: 18-25
• 8 Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F. et al Incidence rates of post-ERCP complications: A systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-8
• 9 McInnis WD, Aust JB, Cruz AB, Root HD. Traumatic injuries of the duodenum: A comparison of 1 degrees closure and the jejunal patch. J Trauma 1975; 15: 847-53