Retroperitoneal perforation post ERCP

Case contributed by Dr Balint Botz

Presentation

ERCP performed due to cholestasis and choledocholithiasis, with pancreatic duct stenting. Retroperitoneal perforation suspected during the procedure. Dull abdominal pain.

Patient Data

Age: 85 years
Gender: Female
  • Retroperitoneal perforation, the pattern of free air is indicative of the duodenum being the site of origin. 
  • Main pancreatic duct stent in situ. 
  • Gallbladder hydrops, sludge, gallstones.
  • Other: hepatic and kidney cysts, diverticulosis, small abdominal hernia, signs of prior operations with scarring on both kidneys.

Case Discussion

Retroperitoneal perforation is one of the potential complications of ERCP. Significant free gas can be immediately picked up fluoroscopically during the procedure, whilst the rapidly worsening abdominal pain post-procedure is also a concerning sign. 

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