Theopistos Vasileios, Theocharis Georgios, Konstantakis Christos, Kitrou Panagiotis, Kehagias Ioannis, Triantos Christos, Thomopoulos Konstantinos
Department of Gastroenterology, University Hospital of Patras, Patras, Greece.
Department of Diagnostic and Interventional Radiology, University Hospital of Patras, Patras, Greece.
Gastroenterology Res. 2018 Jun;11(3):207-212. doi: 10.14740/gr1007w. Epub 2018 May 31.
No consensus exists on treatment of endoscopic retrograde cholangiopancreatography (ERCP) -related, retroperitoneal duodenal perforations. The aim of this study is to determine the incidence of post-ERCP retroperitoneal periampullary (type 2) duodenal perforations and the clinical outcome of non-surgical management.
Patients who underwent ERCP in our institution during the period from January 1, 2009 to December 31, 2017 were included. Any cases of retroperitoneal periampullary duodenal (type 2) perforation were identified. Relevant data (patient characteristics, indications, radiographic findings, time to diagnosis and surgery, surgical procedures, hospital stay and outcome) were retrospectively collected and reviewed. Results were compared to those from the existing literature.
There were 24 patients with retroperitoneal type 2 duodenal perforation following 4,196 ERCPs were identified (24/4196, 0.57%) over the 9-year period. ERCP indications were: choledocholithiasis, obstructive jaundice and ampullectomy (ampullary adenoma). Diagnosis (aided by CT scan) was established within the first 12 h in the majority of patients (21/24, 87.5%) and intraprocedural in 3/24, (12.5%). Twelve patients (50%) with deteriorating clinical course were managed with CT-guided percutaneous drainage. Surgical intervention was required in two (8.3%). Overall mortality was 4.2%, 1/24 (one patient died after surgery).
Retroperitoneal duodenal perforation is a rare and severe ERCP complication. However, conservative management is feasible in the majority of cases.
对于内镜逆行胰胆管造影术（ERCP）相关的腹膜后十二指肠穿孔的治疗，目前尚无共识。本研究的目的是确定ERCP术后腹膜后壶腹周围（2型）十二指肠穿孔的发生率以及非手术治疗的临床结局。
纳入2009年1月1日至2017年12月31日期间在我院接受ERCP的患者。识别出所有腹膜后壶腹周围十二指肠（2型）穿孔病例。回顾性收集并审查相关数据（患者特征、适应证、影像学检查结果、诊断和手术时间、手术方式、住院时间和结局）。将结果与现有文献进行比较。
在9年期间，4196例ERCP术后共识别出24例腹膜后2型十二指肠穿孔患者（24/4196，0.57%）。ERCP的适应证为：胆总管结石、梗阻性黄疸和壶腹切除术（壶腹腺瘤）。大多数患者（21/24，87.5%）在最初12小时内通过CT扫描确诊，3/24（12.5%）在术中确诊。12例（50%）临床病程恶化的患者接受了CT引导下经皮引流治疗。2例（8.3%）需要手术干预。总体死亡率为4.2%，1/24（1例患者术后死亡）。
腹膜后十二指肠穿孔是一种罕见且严重的ERCP并发症。然而，在大多数情况下，保守治疗是可行的。
