A Case of Gastric and Esophageal Perforation Caused by Endoscopic Retrograde Cholangiopancreatography

Abstract

Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is no longer in use as a diagnostic procedure but rather when a therapeutic intervention is needed or most likely to be needed depending on the pre-ERCP imagings as transabdominal ultrasonography (TAUS), endoscopic ultrasonography (EUS), magnetic resonance cholangiopancreatography (MRCP), because it is an invasive procedure with potential life-threatening complications specially perforation, because most of the diagnosis that ERCP can provide, can be solved by the above mentioned cross sectional imagings. One the most serious complication of this widely used intervention is perforation. We present a case of ERCP-induced perforation of the lesser curvature and esophagus with literature review. Presentation of Case: A 90 years old female patient admitted to secondary level hospital with chronic abdominal pain, yellow discoloration of skin and sclera. ERCP was planned for differential diagnosis of periampullary tumor. Patient is redirected to Izmir Bozyaka Education and Research Hospital General Surgery Department for iatrogenic perforation during the procedure starting from lesser curvature of the stomach extending to thoracic esophagus. Unconsciousness, hypotension (70/40mmHg), tachycardia (140/min) tachypnea (24/min) were the first presenting symptoms. Body temperature was 38ºC. Generalized tenderness and rigidity were presented during abdominal examination. An emergency operation was planned with these findings. Operation including total gastrectomy, transhiatal esophagectomy and feeding jejunostomy was the definitive surgery performed. At postoperative 14th day the patient lost her life after sudden cardiac arrest. Discussion and Conclusion: ERCP has some complication risks like every invasive procedure. Early diagnosis and correct management are crucial in the management of the intervention related complications.