[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-432138-105":59,"doc-detail-432138-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","life-threatening-duodenal-perforation-following-endoscopic-retrograde-cholangiopancreatography-in-an-elderly-patient-a-case-report","Life-Threatening Duodenal Perforation Following Endoscopic Retrograde Cholangiopancreatography in an Elderly Patient - A Case Report","","Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic procedure for pancreaticobiliary disorders, but may rarely result in severe complications such as duodenal perforation. A 77-year-old man with multiple comorbidities presented with painless obstructive jaundice. MRCP findings prompted ERCP, but difficult cannulation requiring precut sphincterotomy led to suspected duodenal perforation with extensive air spread. CT confirmed a third-portion duodenal perforation, treated with emergency Graham patch repair; the patient later developed septic shock, multi-organ failure, and died nine days after. The case emphasizes ERCP-related catastrophic risk and the need for early CT diagnosis and individualized management in high-risk patients.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/life-threatening-duodenal-perforation-following-endoscopic-retrograde-cholangiopancreatography-in-an-elderly-patient-a-case-report/432138/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/life-threatening-duodenal-perforation-following-endoscopic-retrograde-cholangiopancreatography-in-an-elderly-patient-a-case-report/432138.png","ImageObject",300,407,{"name":92,"@type":93},"supergirl","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main complication described after ERCP in this case?","Question",{"text":112,"@type":113},"The patient developed a life-threatening duodenal perforation following ERCP, with extensive air spread to the subcutaneous tissue, retroperitoneum, and mediastinum.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the duodenal perforation confirmed and guided for management?",{"text":117,"@type":113},"CT confirmed free intraperitoneal air and contrast extravasation in the retroperitoneal space anterior to the left renal fascia, consistent with perforation of the third portion of the duodenum.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment was used after emergency diagnosis?",{"text":121,"@type":113},"Emergency laparotomy identified and repaired the defect with a Graham patch, followed by intensive care with broad-spectrum antimicrobials and vasopressors.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},432138,1790715555,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 11/09/2025  \nReview ended 11/21/2025  \nPublished 12/05/2025  \n© Copyright 2025  \nTheocharidou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98498  \nOpen Access Case Report  \nLife-Threatening Duodenal Perforation Following Endoscopic Retrograde Cholangiopancreatography in an Elderly Patient:  \nA Case Report  \nChristina Chrysanthi Theocharidou 1, Fotini Ampatzidou 2, Savvas Simeonidis 3, Andreas Papadimos 4, Athina Lavrentieva 2  \n1. Internal Medicine and Critical Care, General Hospital of Thessaloniki \"G.Papanikolaou \", Thessaloniki, GRC 2. Critical Care, General Hospital of Thessaloniki \"G.Papanikolaou \", Thessaloniki, GRC 3. Surgery, General Hospital of Thessaloniki \"G.Papanikolaou \", Thessaloniki, GRC 4. Internal Medicine, General Hospital of Thessaloniki  \n\"G.Papanikolaou \", Thessaloniki, GRC  \nCorresponding author: Christina Chrysanthi Theocharidou, [chrtheoch@hotmail.gr](chrtheoch@hotmail.gr)  \nAbstract  \nEndoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic procedure for pancreaticobiliary disorders, but may rarely result in severe complications such as duodenal perforation. A 77-year-old man with hypertension, diabetes, dyslipidemia, and benign prostatic hyperplasia presented with painless obstructive jaundice for a duration of four weeks. Laboratory tests showed a cholestatic pattern and elevated carbohydrate antigen 19-9. Magnetic resonance cholangiopancreatography (MRCP) demonstrated marked dilation of the common bile duct with abrupt distal tapering, mild pancreatic duct dilation, and a periampullary diverticulum, suggesting a periampullary neoplastic lesion or fibrotic stenosis. An ERCP was performed for diagnostic clarification and potential therapeutic decompression. Difficult cannulation required a precut sphincterotomy, after which a duodenal perforation was suspected. Postprocedure, the patient developed extensive subcutaneous, retroperitoneal, and mediastinal emphysema, pneumopericardium, and bilateral pneumothoraces. A CT confirmed free intraperitoneal air and contrast extravasation in the retroperitoneal space anterior to the left renal fascia, consistent with a perforation of the third portion of the duodenum. Emergency laparotomy identified and repaired the defect with a Graham patch. Despite intensive care with broad-spectrum antimicrobials and vasopressors, the patient developed septic shock and multi-organ failure and died nine days later. This case underscores the catastrophic potential of ERCP-related duodenal perforation and the importance of early CT diagnosis and individualized intervention in high-risk patients.  \nCategories: General Surgery, Emergency Medicine, Gastroenterology  \nKeywords: duodenal perforation, endoscopic retrograde cholangiopancreatography (ercp), intensive care unit,  \npancreatic-biliary cancer, pneumothorax  \nIntroduction  \nEndoscopic retrograde cholangiopancreatography (ERCP) is a cornerstone diagnostic and therapeutic  \nprocedure for managing a wide spectrum ofbiliary and pancreatic diseases. Although generally safe when performed by experienced endoscopists, it carries a recognized risk of complications, including pancreatitis, hemorrhage, infection, and perforation. Among these, duodenal perforation is one of the most serious and  \npotentially fatal complications, with mortality rates reported as high as 18%[1] .  \nThe clinical presentation of ERCP-related perforation is often variable and nonspecific, ranging from mild abdominal discomfort to rapidly progressive, life-threatening peritonitis. The CT remains the diagnostic  \ngold standard, allowing for the detection of extraluminal air, contrast leakage, and associated fluid  \ncollections that guide further management. Treatment options ran","cbCaibruGlguEWDS","https://ap.wps.com/l/cbCaibruGlguEWDS","pdf",4634528,"English","# Abstract\n# Introduction\n# Case Presentation\n# Laboratory Values\n## Table 1: Laboratory values at hospital admission (before ERCP) and on day 9 after ICU admission","[{\"question\":\"What is the main complication described after ERCP in this case?\",\"answer\":\"The patient developed a life-threatening duodenal perforation following ERCP, with extensive air spread to the subcutaneous tissue, retroperitoneum, and mediastinum.\"},{\"question\":\"How was the duodenal perforation confirmed and guided for management?\",\"answer\":\"CT confirmed free intraperitoneal air and contrast extravasation in the retroperitoneal space anterior to the left renal fascia, consistent with perforation of the third portion of the duodenum.\"},{\"question\":\"What treatment was used after emergency diagnosis?\",\"answer\":\"Emergency laparotomy identified and repaired the defect with a Graham patch, followed by intensive care with broad-spectrum antimicrobials and vasopressors.\"}]","Life-Threatening Duodenal Perforation Following Endoscopic Retrograde Cholangiopancreatography in an Elderly Patient - A Case Report | PDF",1790658254]