Small duodenal perforations during ERCP-sphincterotomy are not rare and most perforations cause pneumoretroperitoneum, although pneumoperitoneum is also possible. Often the radiologist or resident is the first one to notice and therefore it is their task to detect and warn the physician of this complication. Furthermore, imaging is used to follow-up, to rule out further complications such as abscess formation or pancreatitis, and if needed, to guide abscess drainage.