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Abdominal Imaging

, Volume 25, Issue 3, pp 279–282 | Cite as

Retroperitoneal perforation during endoscopic sphincterotomy: imaging findings

  • R. Zissin
  • M. Shapiro-Feinberg
  • A. Oscadchy
  • I. Pomeranz
  • G. Leichtmann
  • B. Novis
Article

Abstract

Background: Endoscopic retrograde cholangiopancreatography with sphincterotomy has become an important technique in the diagnosis and treatment of biliary and pancreatic diseases. Serious complications, although rare, may occur, and their early recognition and treatment are of the utmost importance. We encountered several such cases. This study reviews the imaging findings in patients with retroperitoneal perforation detected after the procedure.

Methods: Of 796 patients who had endoscopic sphincterotomy at our institution during a 9-year period, retroperitoneal perforation occurred in nine (1.13%). Imaging findings and clinical outcome were assessed.

Results: In eight patients, routine abdominal radiographs taken during the procedure disclosed retroperitoneal air, associated with extravasation of contrast material in six patients. This was further confirmed on computed tomography (CT) in three patients. In the ninth patient, the diagnosis was established by an emergent abdominal CT performed a day after the sphincterotomy, because of severe abdominal pain. Two patients died of overwhelming sepsis.

Conclusions: Retroperitoneal perforation during endoscopic sphincterotomy is a rare complication, which occurred in 1.13% of our patients. It can be usually clearly recognized radiographically by an abdominal film and in doubtful cases by CT. We emphasize the importance of recognizing this potentially serious complication with imaging studies.

Key words: ERCP, sphincterotomy—Common bile duct, perforation—Retroperitoneal space, CT. 

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Copyright information

© Springer-Verlag New York Inc. 2000

Authors and Affiliations

  • R. Zissin
    • 1
  • M. Shapiro-Feinberg
    • 1
  • A. Oscadchy
    • 1
  • I. Pomeranz
    • 2
  • G. Leichtmann
    • 2
  • B. Novis
    • 2
  1. 1.Department of Diagnostic Imaging, Meir Hospital, Sapir Medical Center, Kfar Saba, affiliated with the Sackler School of Medicine, Tel Aviv University, Kfar Saba, 44281, IsraelIL
  2. 2.Department of Gastroenterology, Meir Hospital, Sapir Medical Center, Kfar Saba, affiliated with the Sackler School of Medicine, Tel Aviv University, Kfar Saba, 44281, IsraelIL

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