Biliary peritonitis after endoscopic retrograde cholangiopancreatography

Occurrence of a perforation after endoscopic CPRE sphincterotomy is a complication previously reported in the literature, with frequent repercussions on the duodenum and the periampullary region (Stapfer types 1 and 2); treatment modalities are strictly codified. During an endoscopic procedure, it may be associated with manipulation of a guide wire, generally leading to isolated pneumoretroperitoneum (Stapfer type 4), which is conservatively treated. Secondarily to endoscopic maneuvers, Stapfer type 3 may also occur, causing pancreatic or biliary ductal lesions. When perforation is highlighted following an endoscopic procedure, treatment depends on the presence of an intraperitoneal or retro-peritoneal liquid or aerial effusion. When perforation is contained and clinical tolerance remains satisfactory, conservative treatment is carried out. Conversely, in the event of poor tolerance or intraperitoneal contamination, emergency surgery is called for. (C) 2021 Elsevier Masson SAS. All rights reserved.

Automated summary

Perforation after endoscopic sphincterotomy during CPRE can lead to different types of complications, with treatment modalities determined by the extent of the perforation and patient tolerance. Conservative treatment or emergency surgery may be required based on the clinical situation.