Retrograde endocardial retrograde cholangiopancreatography duodenal perforation: Hospital de San José February 2001 to February 2007 Perforación duodenal post-colangiopancreatografía retrógrada endocópica: Hospital de San José febrero de 2001 a febrero de 2007

Abstract

Introduction: duodenal perforation is one of the main complications of endoscopic instrumentation of the bile duct and is associated with high mortality. Its traditional management has been surgical although some authors have proposed the expectant with significant results. Materials and methods: a descriptive, retrospective, case series study was performed in patients with duodenal perforation after ERCP, who were managed in the general surgery service of the Hospital of San José, in the period between February 2001 and February. 2007. Demographic data, indications of the procedure, symptoms and time of initiation, diagnostic methods used, surgical findings and mortality were collected. Results: in the period between February 2001 and February 2007, 1,200 ERCPs were performed at the Hospital de San José. Thirteen patients were diagnosed with duodenal perforation; The main symptom present in all was abdominal pain, although in only three of them were signs of peritoneal irritation. The majority were diagnosed in late form (more than 24 hours), three presented shock prior to the surgical procedure, which independent of the type of lesion found in surgery was associated with mortality. In a retrospective manner, each of the patients was classified according to Stapfer et al. The surgical procedure of choice was pyloric exclusion and mortality was 38.46%. Conclusions: duodenal perforation secondary to ERCP is a rare entity, but associated with high mortality, which increases with the severity of the injury and the late management of it. Abbreviations: ERCP, endoscopic retrograde cholangiopancreatography; ICU, intensive care unit; POP, postoperative.