Successful Endoscopic Management of Double Iatrogenic Perforations Induced by Endoscopic Retrograde Cholangiopancreatography and Computed Tomography-Guided Colon Drainage

Case Reports in Gastroenterology
Ping-Hsiu WuKuang-En Chu

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk procedure with a significantly high rate of complications, such as pancreatitis, bleeding, perforation, and infection. Pancreatitis is the most common post-ERCP complication with an incidence of approximately 3.5%. Although perforation is a rare complication with an incidence of 0.1-0.6%, it may be associated with a high rate of mortality of 1.0-1.5%. Here, we report a rare case of ERCP-induced double iatrogenic perforations in the duodenum and colon complicated by an intra-abdominal abscess. The post-ERCP perforation was successfully sealed using fibrin glue (Tisseel). The intra-abdominal abscess was treated with a computed tomography-guided pigtail drainage; however, the pigtail spontaneously migrated and perforated the ascending colon. The pigtail was removed, and closure of the colon perforation was successfully achieved with endoscopic clipping. Tisseel spray can be a treatment option for post-ERCP perforations. Careful consideration of procedural complications, early detection of perforations, and prompt treatment can be life-saving.

References

Jun 1, 2006·Seminars in Interventional Radiology·Jonathan Lorenz, Jamie Lee Thomas
Sep 1, 2011·Digestive Diseases and Sciences·Barjesh Chander SharmaRavisankar Reddy
Dec 17, 2015·World Journal of Gastroenterology : WJG·Hsin-Yeh Yang, Jui-Hao Chen
Mar 16, 2016·Deutsches Ärzteblatt International·Arthur SchmidtAlexander Meining

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Citations

Mar 26, 2021·Case Reports in Surgery·Molly S JainJuaquito M Jorge

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