Pneumoretroperitoneum, Bilateral Pneumothorax and Subcutaneous Emphysema Following Endoscopic Biliary Sphincterotomy

Abstract

We report a case of pneumothorax, subcutaneous emphysema and pneumoretroperitoneum after an endoscopic sphincterotomy. A 40-yr-old woman presented with dyspnea immediately after she had undergone an endoscopic retrograde cholangiopancreatogram for a residual stone in common bile duct. On arrival to our hospital, she complained about severe dyspnea and on examination subcutaneous emphysema was discovered. A CT scan was conducted and showed a right-sided pneumothorax, a pneumoretroperitoneum in the peritoneal cavity. We recommended to the patient an immediate laparotomic exploration. We discovered a duodenal perforation in which we sutured it with accompanying pyloric exclusion, double truncular vagotomy and gastroenteroanastomosis. Endoscopic retrograde cholangiopancreatogram (ERCP) is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperi-toneum, mediastinum, and the soft tissues of the neck, eventually causing pneumothorax. Early recognition and appropriate management is crucial for optimal results.

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A. Makni

A. Makni, M.D. Department of General Surgery ‘A’, La Rabta Hospital Jabbari 1007, Tunis, Tunisia Mobile: [phone] Fax: [phone] E-mail: [email protected]