Surgical Approach to the Pancreatic Head Tumor in an Emergency Setting due to ERCP-Related Duodenal Perforation: A Case Report

Introduction: Duodenal perforation is a rare complication during endoscopic retrograde cholangiopancreatography (ERCP) which requires an emergency approach. Herein we report a case of emergency pancreatoduodenectomy (EPD) for a patient who developed ERCP-related duodenal perforation with an underlying pancreatic head tumor. Case presentation: A 55-year-old man was referred to our gastroenterology unit because of a pancreatic head tumor with a complaint of jaundice. Due to the development of ERCP-related duodenal perforation, the patient that had incomplete tumor staging underwent an emergency operation. To facilitate the early assessment of arterial involvement thus assess prediction of tumor resectability and complex anatomical variations, the mesenteric approach was carried out. The patient's postoperative course was uneventful, and he was discharged from the hospital on day 7 after surgery. Histopathologically, a poorly-differentiated ductal adenocarcinoma was identified and R0 resection was achieved. Conclusions: It should be kept in mind that tumor staging should be completed prior to the ERCP procedure. In an emergency setting, the "mesenteric approach" is more reliable in terms of exposing the SMA (superior mesenteric artery) and identifying vascular anatomy and tumor extension in patients with pancreatic head tumor whose staging has not been completed and anatomy has not been assessed yet.