Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12976-12980
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12976
Endoscopic fibrin sealant closure of duodenal perforation after endoscopic retrograde cholangiopancreatography
Hsin-Yeh Yang, Jui-Hao Chen
Hsin-Yeh Yang, Jui-Hao Chen, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
Jui-Hao Chen, Faculty of Medicine, Taipei Medical University, Taipei 11101, Taiwan
Author contributions: Both authors contributed to the acquisition of data, preparation and revision of this manuscript.
Supported by Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Informed consent statement: The patient involved in this study provided written informed consent authorizing use and disclosure of his health information.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jui-Hao Chen, MD, Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih-Lin District, Taipei 11101, Taiwan. m000723@ms.skh.org.tw
Telephone: +886-2-28332211-2031 Fax: +886-2-28389335
Received: April 30, 2015
Peer-review started: May 8, 2015
First decision: July 10, 2015
Revised: August 5, 2015
Accepted: October 13, 2015
Article in press: October 13, 2015
Published online: December 7, 2015
Processing time: 219 Days and 17.6 Hours
Abstract

Traditionally, perivaterian duodenal perforation can be managed conservatively or surgically. If a large volume of leakage results in fluid collection in the retroperitoneum, surgery may be necessary. Our case met the surgical indication for perivaterian duodenal perforation after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic papillary balloon dilatation. The patient developed a retroperitoneal abscess after the procedures, and a perivaterian perforation was suggested on computed tomography (CT). CT-guided abscess drainage was performed immediately. We unsuccessfully attempted to close the perforation with hemoclips initially. Subsequently, we used fibrin sealant (Tisseel) injection to occlude the perforation. Fibrin sealant injections have been previously used during endoscopy for wound closure and fistula repair. Based on our report, fibrin sealant injection can be considered as an alternative method for the treatment of ERCP-related type II perforations.

Keywords: Perivaterian duodenal perforation; Endoscopic retrograde cholangiopancreatography; Retroperitoneal abscess

Core tip: Perivaterian duodenal perforation can be managed conservatively or surgically. Our patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic papillary balloon dilatation, and developed a perivaterian duodenal perforation after the procedures. Computed tomography-guided abscess drainage was performed immediately but without improvement, and fibrin sealant (Tisseel) injection was then administered to occlude the perforation. The patient recovered uneventfully. This report shows that fibrin sealant injection can be an alternative method for the treatment of ERCP-related type II perforations.