Papillary injuries and duodenal perforation during endoscopic retrograde sphincterotomy (ERS): Radiological findings

Objective: To describe the radiological features of duodenal injury during endoscopic retrograde sphincterotomy (ERS) with special reference to limited papillary trauma and minor perforation. Methods: The radiological and clinical features of duodenal injuries out of 284 ERS performed in the last 4 years were evaluated retrospectively to document various patterns of trauma and correlation with clinical outcome. Results: Duodenal injuries occurred in eight patients: mild papillary injuries in five subjects (intrapapillary extravasation of contrast medium in one, peri-Vaterian sub-mucosal diffusion in four) and duodenal perforation in three (peri-choledochal, diffusion in one, retroperitoneal leakage in two). Conclusion: The radiological findings in papillary and duodenal injuries are protean and knowledge of their variable appearance is important since their detection may have practical consequences.