Unusual duodenal perforation following endoscopic retrograde cholangiopancreatography

Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES). Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP) and Computerized Tomography (CT) verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation.