Endoscopic fibrin sealant closure of duodenal perforation after endoscopic retrograde cholangiopancreatography

Figure 1 The patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy and endoscopic papillary balloon dilatation. A: Endoscopic retrograde cholangiopancreatography with sphincterotomy; B: Endoscopic papillary balloon dilatation (0.8 cm, 8 atm × 3 min); C: Black stone (white arrow) was extracted with a balloon catheter.

Figure 2 Computed tomography scan. A: Showing a hypodense abscess (arrow) between the liver and right kidney; B: Showing pig-tail drainage (arrow) of the abscess.

Figure 3 Computed tomography scan of the abdomen. Green arrow showing perforation site.

Figure 4 Endoscopic retrograde cholangiopancreatography. Endoscopic retrograde cholangiopancreatography revealed a perforation (arrow) in the duodenum (A); Two plastic stents were inserted into the endoscopic papillary balloon dilatation before fibrin sealant injection (B); Whitish tissue sealant was injected into the perforation in the right upper corner (C).