Abstracts
1998 Digestive Disease Week

#1046

MANAGEMENT OF DUODENAL PERFORATION AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY. M. V. Stapfer, R. Yang, N. Jabour, S. C. Stain, R. Selby, and D. Garry, University of Southern California, Los Angeles, CA.

ERCP was performed on 1197 patients at LACUSC Medical Center from June 1993 to November 1997, and eleven (0.9%) patients were referred for suspected duodenal perforation.

METHODS: Charts were reviewed for: ERCP indications, clinical presentation of perforation, diagnostic method and time to diagnosis, indications for medical versus surgical treatment, and outcomes. RESULTS: All perforations occurred after ERCP extraction of biliary tract stones. Perforation was most often identified (73%) at ERCP based on extraduodenal extravasation. The immediate clinical presentation was frequently mild (73%) and did not necessarily reflect the extent of extravasation. Five patients (46%) were treated non-operatively whenever: 1) Systemic sepsis, peritonitis, and retained biliary stones were absent; 2) Contrast CT performed subsequent to ERCP did not demonstrate intra or retroperitoneal extravasation or fluid collections. Mean length of stay (MLOS) was 27 days, and all patients recovered without complications. Six patients (54%) failed criteria and required operation. Mortality (33%), reoperation (50%) and MLOS (61 days) were attributable to delay in diagnosis and treatment.

CONCLUSIONS: Early surgical management of ERCP perforation is the standard of care, although certain patients who meet strict radiographic and clinical criteria may be managed nonoperatively.

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