Retroperitoneal abscess after endoscopic sphincterotomy: An unusual and severe complication

We report the case of a 55 year old female patient, previously cholecystectomized, who was admitted to the Hospital because of recurrent biliary abdominal pain, cholestasis and common bile duct enlargement by ultrasonography. 48 hours after an endoscopic sphincterotomy the patient developed abdominal pain and fever. CT scan demonstrated air and an infected liquid collection in the retroperitoneum. Although a percutaneous drainage was attempted, the persistence of the symptoms and the low drainage outflow of the infected material made surgical treatment necessary. Duodenal perforation in endoscopic sphincterotomy is an unusual but severe complication that leads to a high mortality rate if surgical treatment is not applied promptly. Sometimes retropneumoperitoneum can be satisfactory solved just with a conservative medical therapy, but if there is a suspected or confirmed infected collection surgical treatment must be applied promptly.