Presentation
Abdominal pain
Patient Data
ERCP demonstrates extraluminal contrast and a pocket of subhepatic gas. Biliary tree is opacified, along with contrast within the gallbladder revealing numerous gallstones.
Free gas under both hemidiaphragms with patchy lucency in a subhepatic location, most likely pneumoretroperitoneum.
Large volume of retropneumoperitoneum and minor pneumoperitoneum. Free fluid which is within the retroperitoneum with very little intraperitoneal. No contrast leak from the duodenum identified.
Cholelithiasis. Contrast within the gallbladder from the recent ERCP.
Case Discussion
Duodenal perforation post ERCP is rare, occurring in ~1% (range 0.3-1.3%) of cases. Some advocate a non-surgical approach to management in certain select patients.
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