ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report
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Quanpeng Li1,*, Jie Ji2,*, Fei Wang1, Xianxiu Ge1, Junjie Nie1, Boming Xu1, Xiuhua Zhang1, Guobing Jiang1, Lin Miao1
1Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
2Liver Transplantation Center of the First Affiliated Hospital and State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
*These authors have contributed equally to this work
Lin Miao, e-mail: firstname.lastname@example.org
Keywords: duodenal perforation, endoscopic purse-string suture, endoscopic retrograde cholangiopancreatography
Received: March 20, 2015 Accepted: May 26, 2015 Published: June 08, 2015
Duodenal perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP) and is difficult to manage. Recently, endoscopic purse-string suture, using endoloops with endoclips, is a relatively new technology and has provided good clinical results. However, the study and use of endoscopic purse-string suture on duodenal perforation is less and its feasibility and safety are unknown. Here, we report a case of ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture. During ERCP, fluoroscopy revealed abnormal perinephric gas shadowing after breaking and extracting the stones with a stone-removal basket. Then duodenal endoscopy showed an approximately 2.0 cm × 1.5 cm perforation on the lateral duodenal wall, with visible retroperitoneal loose connective tissue. Titanium clips were used to attempt closure of the perforation but failed because of the long diameter of the injury. Therefore, an endoscopic purse-string suture, using endoloops with endoclips, was employed with an Olympus double-lumen endoscope. The perforation was successfully closed. At the 2-month follow-up visit, the patient had no complaints or symptoms. Our case once again proved its feasibility and safety and provided a new perspective for surgeons.
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