Duodenal perforation post ERCP

Case contributed by Dr Henry Knipe


Abdominal pain

Patient Data

Age: 60 years
Gender: Male


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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Case information

rID: 46732
Published: 15th Jul 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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