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Case Reports
. 2024 Jun 20;2024(6):rjae415.
doi: 10.1093/jscr/rjae415. eCollection 2024 Jun.

Pneumo-peritoneum, pneumo-retroperitoneum and subcutaneous emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy-an uncommon complication case report

S Premakrishna  1 , Sreekanthan Gobishangar  2 , Jude Selvakumar Nilojan  1 , Gnanapragasam Vaikunthan  3 , Jothini Thirunavukkarasu  2
Affiliations
Case Reports

Pneumo-peritoneum, pneumo-retroperitoneum and subcutaneous emphysema following endoscopic retrograde cholangiopancreatography with sphincterotomy-an uncommon complication case report

S Premakrishna et al. J Surg Case Rep. .

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is invasive for pancreaticobiliary diseases. Perforation is a rare but severe complication among its associated risks. A 45-year-old female with biliary colic and multiple gallbladder calculi was diagnosed with choledocholithiasis based on imaging showing CBD dilation and gallstones. ERCP was planned for stone removal. Sphincterotomy was performed, but stone retrieval attempts failed, leading to severe pneumo-peritoneum and respiratory compromise. Immediate CBD stenting was done, avoiding surgical intervention. The patient recovered uneventfully, later undergoing laparoscopic cholecystectomy with CBD exploration and stone removal. ERCP-related perforations, rare but severe, involve retroperitoneal air collection. Clinical signs include abdominal discomfort, and imaging confirms diagnosis. Management varies by type, with some requiring surgical repair. Conservative management sufficed in this case, with successful patient recovery. ERCP-related complications like pneumo-peritoneum require prompt diagnosis and conservative management if no perforation is evident.

Keywords: conservative management; endoscopic retrograde cholangiopancreatography (ERCP); pneumo-peritoneum.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
CECT of abdomen (axial plane) shows CBD stones.
Figure 2
Figure 2
Post-ERCP NCCT abdomen shows pneumo-peritoneum (red arrow), pneumo-retroperitoneum, and subcutaneous emphysema (blue arrow)
Figure 3
Figure 3
Post-ERCP NCCT abdomen shows pneumo-retroperitoneum (red arrow).
See this image and copyright information in PMC

References

    1. Arslan U. Post-ERCP complications, risk factors and management of complications. Laparosc Endosc Surg Sci 2021;28:93–8. 10.14744/less.2021.58966. - DOI
    1. Borazan E, Konduk BT. Comparison of early and delayed diagnosis of mortality in ERCP perforations: a high-volume patient experience. Ulus Travma Derg 2020;26:746–53. 10.14744/tjtes.2020.61289. - DOI - PubMed
    1. Schiavon L, Rodrigues RA, Nakao FS, et al. . Subcutaneous emphysema, pneumothorax and pneumomediastinum following endoscopic sphincterotomy. Gastroenterol Res 2010;3:216–8. 10.4021/gr232w. - DOI - PMC - PubMed
    1. Okano N, Ito K, Takuma K, et al. . Prevention and Management of ERCP-Related Complications. Mini-invasive Surgery. 2021;5:29. 10.20517/2574-1225.2021.15. - DOI
    1. Lehmann V, Keller W, Egger B. Systematic review of pneumothoraces after endoscopic retrograde cholangiopancreatography. Swiss Med Wkly 2020;150:w20199. 10.4414/smw.2020.20199. - DOI - PubMed

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