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Case Reports
. 2011 Oct 28;17(40):4539-41.
doi: 10.3748/wjg.v17.i40.4539.

Closure of a persistent sphincterotomy-related duodenal perforation by placement of a covered self-expandable metallic biliary stent

Antonios Vezakis  1 , Georgios Fragulidis, Constantinos Nastos, Anneza Yiallourou, Andreas Polydorou, Dionisios Voros
Affiliations
Case Reports

Closure of a persistent sphincterotomy-related duodenal perforation by placement of a covered self-expandable metallic biliary stent

Antonios Vezakis et al. World J Gastroenterol. .

Abstract

Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic techniques have been described to close a variety of perforations. In this case report, we describe the closure of a persistent sphincterotomy-related duodenal perforation by using a covered self-expandable metallic biliary (CEMB) stent. A 61-year-old Greek woman underwent an endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for suspected choledocholithiasis, and a retroperitoneal duodenal perforation (sphincterotomy-related) occurred. Despite initial conservative management, the patient underwent a laparotomy and drainage of the retroperitoneal space. After that, a high volume duodenal fistula developed. Six weeks after the initial ERCP, the patient underwent a repeat endoscopy and placement of a CEMB stent with an indwelling nasobiliary drain. The fistula healed completely and the stent was removed two weeks later. We suggest the transient use of CEMB stents for the closure of sphincterotomy-related duodenal perforations. They can be placed either during the initial ERCP or even later if there is radiographic or clinical evidence that the leakage persists.

Keywords: Complications; Duodenal perforation; Endoscopic sphincterotomy; Metallic stent; Retroperitoneal perforation.

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Figures

Figure 1
Figure 1
Free gas in the retroperitoneal space.
Figure 2
Figure 2
Computed tomography scan showing the presence of air in the retroperitoneal space and subcutaneous emphysema.
Figure 3
Figure 3
The laceration is evident just below the lower end of the bile duct.
Figure 4
Figure 4
Injection of contrast from the endoscope enables visualization of the fistulous tract. The bile duct is also delineated with the presence of gas.
Figure 5
Figure 5
The covered self-expandable metallic biliary stent covers the laceration.
Figure 6
Figure 6
Covered self-expandable metallic biliary stent and nasobiliary catheter in place.
See this image and copyright information in PMC

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