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Abstract
Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
References
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Fig. 1.
(A) CT finding. Contrast-enhanced coronal reformatted CT image showed abrupt narrowing of the extrahepatic bile duct caused by the invasion of gallbladder cancer. (B) ERCP finding. A 7 Fr pigtail catheter was inserted into the left intrahepatic duct. (C) Duodenoscopic finding. Pus-like materials were drained after 10 Fr plastic stent insertion. (D) ERCP finding. A 10 Fr plastic stent was inserted into the left intrahepatic duct.
Fig. 2.
(A) CT finding. Contrast-en-hanced coronal reformatted CT image showed duodenal perforation caused by the plastic biliary stent and soft tissue strandings around the duodenum. (B) ERCP finding. The distal end of the straight plastic stent penetrated the duodenal wall. (C-H) Duodenoscopic findings. (C) A 10 Fr straight plastic stent penetrated the duodenal wall at the opposite side of ampulla. (D) A plastic stent was removed using a stent forcep. (E) Perforated hole in the duodenum (arrow) was confirmed after the removal of plastic stent. (F) Perforated hole was closed using the three hemoclips. (G) Three clips were used as buttress to perform additional approximation using detachable snare. (H) After 2 weeks of procedure, the previous perforated site was completely healed.
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