Management, Duodenum, Perforation, ERCP"/> Management of Duodenal Perforations after Endoscopic Retrograde Cholangiopancreatography
Korean J Gastrointest Endosc > Volume 42(2); 2011 > Article
Korean Journal of Gastrointestinal Endoscopy 2011;42(2): 83-89.
내시경적 역행성 담췌관조영술 후 발생한 십이지장 천공에 대한 치료
김종현ㆍ이건영ㆍ안승익ㆍ홍기천ㆍ정석*ㆍ이돈행*ㆍ최윤미ㆍ최선근ㆍ허윤석ㆍ김세중ㆍ조영업ㆍ신석환ㆍ김경래
인하대학교 의학전문대학원 외과학교실, *내과학교실
Management of Duodenal Perforations after Endoscopic Retrograde Cholangiopancreatography
Jong-Hyun Kim, M.D., Keon-Young Lee, M.D., Seung-Ik Ahn, M.D., Kee Chun Hong, M.D., Seok Jung, M.D.*, Don Haeng Lee, M.D.*, Yun-Mee Choe, M.D., Sun Keun Choi, M.D., Yoon-Seok Hur, M.D., Sei Joong Kim, M.D., Young Up Cho, M.D., Seok-Hwan Shin, M.D. and Kyu
Departments of Surgery, *Internal Medicine, Inha University School of Medicine, Incheon, Korea
Abstract

Background/Aims:
Surgery has been the mainstay of treatment for duodenal perforations after the introduction of endoscopic retrograde cholangiopancreatography (ERCP). Yet there have recently been arguments that conservative management with or without endoscopic intervention may be possible and safe.


Methods:
For the patients who received ERCP at Inha University Hospital from Jan. 2001 to Dec. 2007, we retrospectively analyzed the clinical manifestations, the treatment and the clinical outcomes of the cases with duodenal perforation.
Results:
Among the 1708 ERCP cases, duodenal perforation occurred in eleven (0.6%) patients. There were two cases of duodenal perforations (type I), four cases of peri-Vaterian injury (type II), two cases of bile duct perforations (type III) and three cases of retroperitoneal perforations (type IV). Six patients (55%) were treated surgically while the others were managed conservatively. Except for one death (9.1%), ten patients fully recovered. Either residual diseases or fluid collections, as seen on CT, were present in the surgically managed patients. The median time interval between ERCP and surgery was 19 hours (range: 8∼30 hours).


Conclusions:
To decide on the management of duodenal perforation after ERCP, the presence of residual disease or the leakage of intraluminal contents should be considered along with the type of the perforation. (Korean J Gastrointest Endosc 2011;42:83-89)

Key Words: Management, Duodenum, Perforation, ERCP
주요어: 내시경적 역행성 담췌관조영술, 십이지장, 천공, 치료
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