Early Management Experience of Perforation after ERCP

Table 1

Patient demographics, ERCP indications, presentation and management of perforation, and outcome.

Age/sex	Comorbidities	ERCP indications	Type of ES	Clinical presentation	Type of perforation	Management	Length of stay (d)
56/M	Pancreatitis	CBD stones	—	Abdominal pain	Lateral duodenal; perforation	Closure with six clips; Surgery after perforation healing	23
72/F	COPD	CBD stones	—	Abdominal pain	Lateral duodenal; perforation	Closure with five clips	14
88/M	HBP; CAD	CBD stones	Standard	Peritonitis	Lateral duodenal; perforation	Surgery (suture lesion and drainage abdominal cavity)	25
50/F	—	CBD stones	Standard	Emphysema	Retroperitoneal; Perforation	ENBD; Gastrointestinal decompression	12
58/M	—	CBD stones	Standard	Emphysema; Abdominal pain (PEP)	Retroperitoneal; Perforation	ENBD; Gastrointestinal decompression	14
80/F	Pancreatitis; HBP; CAD	CBD stones	—	Symptomless for this perforation	Fundus perforation	Closure with five clips; Next ERCP performed after 10 days	19
57/F	—	CBD stones	Pre-cut	Emphysema	Retroperitoneal; Perforation	ENBD, ERPD,; Gastrointestinal decompression	14
59/F	SAP; HBP	CBD stones	Standard	Emphysema	Retroperitoneal; Perforation	ENBD, ERPD; Gastrointestinal decompression	22
67/M^*	Arthrolithiasis; COPD, Billroth II; gastrectomy	CBD stones	Standard	Abdominal pain; Incision bleeding	Retroperitoneal; Perforation	ENBD; Gastrointestinal decompression	25
60/F	Pancreatitis; HBP	CBD stones	Pre-cut	Symptomless	Retroperitoneal; Perforation	ENBD; Gastrointestinal decompression	7
60/M	COPD	Cholangio-carcinoma	—	Peritonitis	Afferent limb perforation	Surgery (suture lesion and drainage abdominal cavity and CBD)	18
53/F	—	CBD stones	—	Peritonitis	Afferent limb perforation	Surgery (suture lesion, T-tube drainage after removing CBD stones, and drainage of abdominal cavity)	14
56/M	Diabetes	CBD stones	—	Peritonitis	Afferent limb perforation	Surgery (suture lesion, T-tube drainage after removing CBD stones, and drainage of abdominal cavity)	13
63/F	—	CBD stones	Pre-cut	Emphysema	Retroperitoneal; Perforation	ENBD, ERPD; Gastrointestinal decompression	7
65/M	—	CBD stones	Standard	Emphysema	Retroperitoneal; Perforation	ENBD; Gastrointestinal decompression	7
58/F	—	CBD stones	Standard	Symptomless	Retroperitoneal; Perforation	ENBD; Gastrointestinal decompression	6

The conservative treatment included ENBD, NG suction, fasting, intravenous fluids, PPI, somatostatin (SS) and broad-spectrum antibiotics for 5 to 7 days. ^*The patient had to take NSAID for two years, and had complicated preampullary perforation and incision bleeding. The incision bleeding stopped by conservative treatment through adding antihemorrhagic 24 h after perforation.