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World J Gastroenterol. Apr 21, 2015; 21(15): 4770-4772
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4770
Air leak syndrome after endoscopic retrograde cholangiopancreatography: A rare and fatal complication
Bulent Yilmaz, Emir Charles Roach, Seyfettin Koklu, Onur Aydin, Ozan Unlu, Yusuf Alper Kilic
Bulent Yilmaz, Emir Charles Roach, Seyfettin Koklu, Ozan Unlu, Department of Gastroenterology, Hacettepe University School of Medicine, Ankara 06100, Turkey
Onur Aydin, Yusuf Alper Kilic, Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
Author contributions: Aydin O and Kilic YA performed the surgery and clinical care of the patient; Yilmaz B, Roach EC and Unlu O wrote the manuscript; Koklu S organized the patient’s data.
Conflict-of-interest: The authors declare no conflicting interests related to this paper.
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: Emir Charles Roach, MD, Department of Gastroenterology, Hacettepe University School of Medicine, Sihhiye, Beytepe Mah, Ankara 06100, Turkey. emirroach@yahoo.com
Telephone: +1-216-8488870 Fax: +1-216-6360104
Received: July 22, 2014
Peer-review started: July 23, 2014
First decision: October 14, 2014
Revised: October 28, 2014
Accepted: February 12, 2015
Article in press: February 13, 2015
Published online: April 21, 2015
Processing time: 271 Days and 15.2 Hours
Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a state of the art diagnostic and therapeutic procedure for various pancreatic and biliary problems. In spite of the well-established safety of the procedure, there is still a risk of complications such as pancreatitis, cholangitis, bleeding and perforation. Air leak syndrome has rarely been reported in association with ERCP and the optimal management of this serious condition can be difficult to establish. Our group successfully managed a case of air leak syndrome following ERCP which was caused by a 3cm Stapfer type I perforation in the posterolateral aspect of the second part of the duodenum and was repaired surgically. Hereby, we describe the presentation and subsequent therapeutic approach.

Keywords: Air leak syndrome; Endoscopic retrograde cholangiopancreatography; Complication; Perforation; Stapfer

Core tip: Diagnosis and management of air leak syndrome following endoscopic retrograde cholangiopancreatography (ERCP) can be challenging, complex and may be delayed because clinical findings can resemble those of pancreatitis. Moreover, ERCP-related perforation, as seen in our case hereby presented, is uncommon but has a high mortality rate. Stapfer et al classified ERCP-related perforations into four major groups. Hereby, we present a case with a Stapfer I type ERCP-related perforation which was successfully repaired surgically.