A Case of Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Sphincterotomy / 대한소화기내시경학회지

ABSTRACT

Perforation complicates endoscopic sphincterotomy (EST) in approximately 1% of cases. However, pneunomediastinum and/or subcutaneous emphysema due to duodenal perforation after EST have rarely been reported. The management strategy of this awkward complication of EST remains controversial. Conservative treatment with antibiotics and nasogastric and/or biliary drainage has been reported to be adequate, but some authors still advocate early surgery for all perforations. Therefore, it seems necessary to accumulate more data in order to set up a management algorithm in these cases. Recently, we experienced a case of pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema developed after EST and stone removal in which recovery was achieved with conservative treatment in a 87-year-old woman with previous Billroth II partial gastrectomy. We herein report this rare complication of EST and a management algorithm is suggested based on a literature review.