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On-line Access: 2010-01-01

Received: 2009-06-25

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Crosschecked: 2009-12-14

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Journal of Zhejiang University SCIENCE B 2010 Vol.11 No.1 P.17-21


Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation

Author(s):  Zuo-bing CHEN, Zhong-yan LIANG, Yun ZHANG, Shao-yang ZHANG, Shu-sen ZHENG

Affiliation(s):  Department of Emergency Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more

Corresponding email(s):   chenzuobing@hotmail.com, bigzyun1@sina.com

Key Words:  Endoscopic retrograde cholangiopancreatography (ERCP), Post-ERCP-pancreatitis (PEP), Duodenum perforation, Debridement, Drainage

Zuo-bing CHEN, Zhong-yan LIANG, Yun ZHANG, Shao-yang ZHANG, Shu-sen ZHENG. Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation[J]. Journal of Zhejiang University Science B, 2010, 11(1): 17-21.

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author="Zuo-bing CHEN, Zhong-yan LIANG, Yun ZHANG, Shao-yang ZHANG, Shu-sen ZHENG",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation
%A Zuo-bing CHEN
%A Zhong-yan LIANG
%A Shao-yang ZHANG
%A Shu-sen ZHENG
%J Journal of Zhejiang University SCIENCE B
%V 11
%N 1
%P 17-21
%@ 1673-1581
%D 2010
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B0900175

T1 - Surgical intervention of severe post-ERCP-pancreatitis accompanied with duodenum perforation
A1 - Zuo-bing CHEN
A1 - Zhong-yan LIANG
A1 - Yun ZHANG
A1 - Shao-yang ZHANG
A1 - Shu-sen ZHENG
J0 - Journal of Zhejiang University Science B
VL - 11
IS - 1
SP - 17
EP - 21
%@ 1673-1581
Y1 - 2010
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B0900175

endoscopic retrograde cholangiopancreatography (ERCP) is a procedure widely used to diagnose and treat conditions of biliary or pancreatic ductal system. The post-ERCP severe acute pancreatitis (SAP) accompanied with duodenum perforation is rare but serious, remaining a challenge in clinic. In this study we report two such cases. Two Chinese women were treated for clinical suspicion of bile duct obstruction and underwent ERCP after admission. Both developed duodenum perforation and SAP after ERCP, and were managed in the intensive care unit (ICU) and required an organ-failure support. The surgical intervention of the peri-pancreatic debridement with lumber-abdominal compound incisions and postoperative washing and drainage was performed, and the two patients recovered well. The therapeutic effect of the peri-pancreatic debridement with lumber-abdominal compound incisions combined with postoperative washing and drainage in the patients of severe post-ERCP-pancreatitis (PEP) and duodenum perforation is satisfactory.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1] Balthazar, E.J., Ranson, J.H., Naidich, D.P., Megibow, A.J., Caccavale, R., Cooper, M.M., 1985. Acute pancreatitis: prognostic value of CT. Radiology, 156(3):767-772.

[2] Balthazar, E.J., Robinson, D.L., Megibow, A.J., Ranson, J.H., 1990. Acute pancreatitis: value of CT in establishing prognosis. Radiology, 174(2):331-336.

[3] Castillo, C.F., Rattner, D.W., Makary, M.A., Mostafavi, A., McGrath, D., Warshaw, A.L., 1998. Debridement and closed packing for the treatment of necrotizing pancreatitis. Ann. Surg., 228(5):676-684.

[4] Cheon, Y.K., Cho, K.B., Watkins, J.L., McHenry, L., Fogel, E.L., Sherman, S., Lehman, G.A., 2007. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest. Endosc., 65(3):385-393.

[5] Cotton, P.B., Lehman, G., Vennes, J., Geenen, J.E., Russell, R.C., Meyers, W.C., Liguory, C., Nickl, N., 1991. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc., 37(3):383-393.

[6] Enns, R., Eloubeidi, M.A., Mergener, K., Jowell, P.S., Branch, M.S., Pappas, T.M., Baillie, J., 2002. ERCP-related perforations: risk factors and management. Endoscopy, 34(4):293-298.

[7] Freeman, M.L., Nelson, D.B., Sherman, S., Haber, G.B., Herman, M.E., Dorsher, P.J., Moore, J.P., Fennerty, M.B., Ryan, M.E., Shaw, M.J., et al., 1996. Complications of endoscopic biliary sphincterotomy. N. Engl. J. Med., 335(13):909-918.

[8] Freeman, M.L., DiSario, J.A., Nelson, D.B., Fennerty, M.B., Lee, J.G., Bjorkman, D.J., Overby, C.S., Aas, J., Ryan, M.E., Bochna, G.S., et al., 2001. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest. Endosc., 54(4):425-434.

[9] Genzlinger, J.L., McPhee, M.S., Fisher, J.K., Jacob, K.M., Helzberg, J.H., 1999. Significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Am. J. Gastroenterol., 94(5):1267-1270.

[10] Jean-Louis, F., Michael, L.S., Catherine, M.P., 2008. Acute pancreatitis. Lancet, 2008(371):143-152.

[11] Johnson, C.D., Abu-Hilal, M., Members of the British Acute Pancreatitis Study Group, 2004. Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis. Gut, 53(9):1340-1344.

[12] Knaus, W.A., Draper, E.A., Wagner, D.P., Zimmerman, J.E., 1985. APACHE II: a severity of disease classification system. Crit. Care Med., 13(10):818-829.

[13] Marshall, J.C., Cook, D.J., Christou, N.V., Bernard, G.R., Sprung, C.L., Sibbald, W.J., 1995. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit. Care Med., 23(10):1638-1652.

[14] Mayumi, T., Ura, H., Arata, S., Kitamura, N., Kiriyama, I., Shibuya, K., Sekimoto, M., Nago, N., Hirota, M., Yoshida, M., et al., 2002. Evidence-based clinical practice guidelines for acute pancreatitis: proposals. J. Hepatobiliary Pancreat. Surg., 9(4):413-422.

[15] Salminen, P., Laine, S., Gullichsen, R., 2008. Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center. Surg. Endosc., 22(9):1965-1970.

[16] Stapfer, M., Selby, R.R., Stain, S.C., Katkhouda, N., Parekh, D., Jabbour, N., Garry, D., 2000. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann. Surg., 232(2):191-198.

[17] Uhl, W., Warshaw, A., Imrie, C., Bassi, C., McKay, C.J., Lankisch, P.G., Carter, R., DiMagno, E., Banks, P.A., Whitcomb, D.C., et al., 2002. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology, 2(6):565-573.

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