THE MANAGEMENT OF PERFORATION OF THE DUODENUM FOLLOWING ENDOSCOPIC SPHINCTEROTOMY - A PROPOSAL FOR SELECTIVE THERAPY

The successful non-surgical management of retroduodenal perforation fo llowing endoscopic sphincterotomy is reported and the literature revie wed. Two patients are described who developed gas in the retroperitone um following endoscopic sphincterotomy, One patient developed retroper itoneal emphysema and cervical emphysema, while the second patient dev eloped retroperitoneal emphysema and a pneumothorax following endoscop ic sphincterotomy. Both patients were treated conservatively and made uneventful recoveries. An algorithm for assessment and treatment is pr oposed based on the authors' experience and a literature review. Patie nts with confirmed ongoing duodenal leakage, sepsis or collection shou ld have expeditious surgery.