Early surgical management for periampullary retroperitoneal perforation caused by endoscopic sphincterotomy: report of a case.

A 67-year-old woman was admitted to our hospital for surgical management of cancer of the ascending colon. On admission, she had cholangitis due to choledocholithiasis. Abdominal computed tomography, ultrasonography, and magnetic resonance showed cholelithiasis, choledocholithiasis, and multiple liver tumors. Colonoscope showed advanced cancer of the ascending colon. Because of acute obstructive suppurative cholangitis, endoscopic sphincterotomy was performed. During the procedure, periampullary retroperitoneal perforation was identified on radiologic examination. Because computed tomography had shown extravasation of contrast medium and widespread pneumoretroperitoneum, an emergency operation was performed 2 hours after perforation. After cholecystectomy and choledocholithotomy had been performed and all bile duct stones had been removed, periampullary perforation was readily identified close to the duodenal diverticula and easily repaired. The postoperative course was uneventful. This patient could resume oral feeding soon after the operation, and colonic surgery could be performed immediately thereafter. Therefore, early surgical management is a possible first choice of treatment in patients with remaining biliary disease after periampullary perforation.