Three cases of duodenal perforation caused by stretching manipulation of endoscope on ERCP

Abstract

The present cases were 62, 63, and 72-year-old males. Duodenal perforation was developed on ERCP for the evaluation of choledocholithiasis and chronic pancreatitis. Perforated site of 2 cases was duodenal second portion and the other was superior duodenal angle. ERCP of all cases was undergone by the operators with less than 40 times of experiences. Although 2 cases whose peritoneal irritation sign appeared immediately required the operation, 1 case with mild abdominal symptoms and lack of inflammatory response in blood findings was cured by only conservative medical management. Duodenal perforation was considered to be caused by stretching manipulation of endoscope. We suggest that operator of ERCP should pay attention to duodenal perforation at the time of stretching manipulation of endoscope, and that conservative management could be acceptable when the abdominal findings are mild, while immediate surgery is required when especially abdominal symptoms got worse or peritoneal perforation developed.