Rare series of complications following ERCP

Introduction: ERCP and EST have an overall complication rate of 2–7%. Most frequent complications are pancreatitis, perforation and haemorrhage. Despite of appropriate treatment mortality is still 0.5–1%. In our case we are presenting a rare series of complications.

Case report: 56 years old female – already had cholecystectomy- presenting with choledocholithiasis underwent ERCP, EST, bile stone extraction. Within an hour the patient developed subcutaneous emphysema and acute abdominal symptoms, CT scan showed pneumoperitoneum, left pneumothorax and pneumopericardium. Chest tube and epidural cannula were inserted. During urgent laparotomy we performed Kocher mobilisation of the duodenum, did not find any perforation, inserted a feeding jejunostomy tube and performed retroperitoneal drainage. CT scan carried out on the 7th postoperative day revealed acute necrotizing pancreatitis. As the patient developed retroperitoneal abscesses while being treated with broad spectrum antibiotics, we performed exploration, necrectomy, irrigation-suction drainage several times. After the remission of the retroperitoneal abscesses a colocutan fistula developed with the patient being afebrile. Though the closure of the fistula was expected, the patient became febrile again, CT scan showed an abscess behind the ascending colon due to the fistula. During the 5th operation the abscess was evacuated, the colon ascendens aperture was sutured and the fistula was excised. The patient was emitted in good clinical condition.

Conclusion: ERCP and EST can have severe complications with poor outcome and requiring multidiscipline interventions. Complications accompanied by pneumothorax and pneumopericardium are rare. Successful treatment can only be achieved by the patient's close observation by the surgeon, the gastroenterologist and the intensivist, usage of appropriate imaging techniques and the urgent treatment of complications identified in time.