Retroperitoneal perforation during endoscopic sphincterotomy: imaging findings

Background: Endoscopic retrograde cholangiopancreatography with sphineterot omy has become an important technique in the diagnosis and treatment of bil iary and pancreatic diseases. Serious complications, although rare, may occ ur, and their early recognition and treatment are of the utmost importance, We encountered several such cases. This study reviews the imaging findings in patients with retroperitoneal perforation detected after the procedure. Method's: Of 796 patients who had endoscopic sphincterotomy at our institut ion during a 9-year period, retroperitoneal preforation occurred in nine (1 .13%). Imaging findings and clinical outcome were assessed. Results: In eight patients, routine abdominal radiographs taken during the procedure disclosed retroperitoneal air, associated with extravasation of c ontrast material in six patients. This was further confirmed on computed to mography (CT) in three patients. In the ninth patient, the diagnosis was es tablished by an emergent abdominal CT performed a day after the sphincterot omy, because of severe abdominal pain. Two patients died of overwhelming se psis. Conclusions: Retroperitoneal perforation during endoscopic sphincterotomy i s a rare complication, which occurred in 1.13% of our patients. It can be u sually clearly recognized radiographically by an abdominal film and in doub tful cases by CT. We emphasize the importance of recognizing this potential ly serious complication with imaging studies.