Subcutaneous Emphysema, Pneumomediastinum, Pneumoperitoneum,and Pneumoretroperitonium: Uncommon Complications of ERCP

Context Endoscopic retrograde cholangiopancreatography is a technique used to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is a safe procedure and serious complications are uncommon. Pneumomediastinum, pneumothorax, pneumoperitoneum and subcutaneous emphysema are rare complications after endoscopic retrograde cholangiopancreatography. Case report An Eighty-year-old woman hospitalized for lower respiratory tract infection was diagnosed with pneumomediastinum, pneumoperitoneum and subcutaneous emphysema after performing an endoscopic retrograde cholangiopancreatography during her hospital stay for increased pancreatic enzymes and dilated common bile duct. With the absence of a perforation site on imaging studies, a conservative treatment was established. The patient was discharged with a very good outcome clinically and radiographically. Discussion This article presents a review of the literature on this rare post endoscopic retrograde cholangiopancreatography complication especially the mechanisms of air leakage in the absence of a perforation site. Conclusion Pneumomediastinum, pneumothorax, pneumoperitoneum and subcutaneous emphysema are rare but serious complications after endoscopic retrograde cholangiopancreatography. Conservative treatment might be appropriate with the absence of a perforation site with a very good outcome.