Surgical Treatment of Duodenal Perforation after Endoscopic Retrograde Cholangiopancreatography (ERCP): A Community Hospital Experience.

Alexander Ramirez Valderrama, MD, Stephen Merola, MD, FACS, Armando Castro, MD, FACS, Joel Ricci, MD, Jason Sample, MD, FACS. New York Hospital Queens.

Introduction Duodenal perforation is a serious rare complication that occurs in about 1% of the patients After ERCP. The aim of the present study was to report the outcomes of patients who underwent surgical treatment of duodenal perforation after ERCP at a community hospital.

Methods A retrospective chart review was performed including all patients who had undergone surgical treatment after ERCP duodenal perforation at a single institution between July 2007 and February 2013.The data analyzed included age, sex, ERCP indications and findings, surgical procedures, postoperative complications and mortality.

Results 12 patients underwent emergency surgery. 11 patients were females (91.6%), main age was 68. The indications for ERCP were choledocolithiasis in 7 patients (58.3%), dilated CBD in 3 patients (25%), dilated pancreatic duct (PD) in 1 (8.3%) and ampullary bleeding in 1 (8.3%). A total of 42 procedures were performed at the initial operation, with a mean of 3.5 procedures for patient. Feeding jejunostomy was done in 8 patients (66.6%), gastrojejunostomy in 7 patients (58.3%), pyloric exclusion in 6 patients (50%), T tube placement in 4 patients (33.3%), cholecystectomy in 3 patients (25%),CBD exploration in 3 patients (25%), enterorrhapy in 2 patients (16.6%)and duodenal primary repair in 2 patients (16.6%), were the most common procedures. Reintervention were required in 5 patients (41.6%), and 8 patients had complications (66.6%, with no 30 days mortality, only 2 delays death occurred from sepsis (16.6%).

Conclusions Duodenal perforation after ERCP that requires surgical intervention has a high rate of complications and mortality, especially in older population.

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