Laparoscopic Repair of Iatrogenic Endoscopic Retrograde Cholangiopancreatography (ERCP)-Induced Duodenal Bulb Perforation in an Elderly Patient With Concomitant Type IV Hiatal Hernia: A Case Report.

Duodenal perforation is a rare but serious complication of endoscopic retrograde cholangiopancreatography (ERCP), particularly when anatomical distortions, such as large hiatal hernias, complicate endoscopic access. This case describes a 93-year-old patient with a type IV hiatal hernia who suffered an iatrogenic duodenal injury during a procedure for acute cholangitis. Due to the size of the defect and the patient's complex anatomy, an emergent laparoscopic repair was performed to reduce the hernia and repair the perforation. The patient's successful recovery highlights that prompt recognition and minimally invasive surgical intervention can be safe and effective, even in geriatric populations where anatomical challenges such as large hiatal hernias increase procedural risk.