Bowel perforation at ERCP
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Vikas Shah had no recorded disclosures.View Vikas Shah's current disclosures
ERCP for obstructing common bile duct stones.
There are cholecystectomy clips. The CBD has been cannulated and a contrast cholangiogram shows intraluminal filling defects consistent with stones. Sphincterotomy and balloon trawl performed and then a biliary stent deployed. Some abdominal pain at end of procedure.
Due to continuing abdominal pain in the recovery period, an urgent medical review was sought and a chest x-ray requested.
Free air seen under both hemidiaphragms in keeping with pneumoperitoneum.
CT abdomen and pelvis
There is a large pneumoperitoneum and also extensive free gas in the retroperitoneum, extending up to the mediastinum. Free fluid is also present. Biliary stents are noted, and pneumobilia is consistent with the recent sphincterotomy. The duodenum is edematous. Normal appearances of the pancreas.
Inverted ERCP images
When the ERCP images shown above are inverted, free air in the right retroperitoneal compartment is more easily identified as bubbly lucency adjacent to the vertebral column.
Perforation of the duodenum is a recognized complication of endoscopic retrograde cholangiopancreatography (ERCP). This case illustrates that careful review of the ERCP images may allow earlier identification of complications such as pneumoperitoneum or pneumoretroperitoneum. Inverting the image enables the bubbly lucency of free air in the retroperitoneum to be more easily discerned.
2 articles feature images from this case
20 public playlists include this case
- mrcp by Tamer mohamed elsawy
- Cases by Tina
- Retroperitoneal Free Gas by Peregrine Dalziel
- Past papers by Sadaf jabeen
- FRCR 2B HPB by Eelin Tan
- abdomen by Tanoj Singh
- AXR by Wang Huijia
- FRCR-long-exam-6 by Radiopaedia.org Rapids
- Medical students- acute abdomen by Gamal Ghazala
- FRANZCR ABDO X-RAY 1 by Babawale S. Niyi
- Fluoro by Taimur
- WART ONLINE TEACHING_AXR by Nathalie Falkner
- Med student teaching by Stephen Davitt
- Abdo Xray Devices by Peregrine Dalziel
- HBP by PRATEEK BHAWSINKA
- ERCP by Luca Merola
- Pneumoperitoneo by Luca Merola
- Retropneumoperitoneo by Luca Merola
- Abdomen 4 - Pneumoperitoneum / Pneumoretroperitoneum by Praveen Samarawickrama
- GI23 by tuanleminh ◉