Significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy

• Published in: The American journal of gastroenterology Vol. 94; no. 5; pp. 1267 - 1270
• Main Authors: GENZLINGER, J. L, MCPHEE, M. S, FISHER, J. K, JACOB, K. M, HELZBERG, J. H
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.05.1999
• Subjects: Adult; Aged; Aged, 80 and over; Air; Biological and medical sciences; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Prospective Studies; Retroperitoneal Space - diagnostic imaging; Sphincterotomy, Endoscopic - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Tomography, X-Ray Computed; Biliary tract; Human; Cholangiopancreatography; Retroperitoneal; Radiodiagnosis; Digestive system; Pathogenesis; Retrograde; Air; Association; Abdominal disease; Surgery; Medical imagery; Complication; Sphincterotomy; Computerized axial tomography; Diagnosis; Pancreas
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.1999.00996.x

We designed a prospective study to determine the frequency of retroperitoneal air after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy. We sought to elucidate the relationship of retroperitoneal air with endoscopic maneuvers, clinical findings, the length of sphincterotomy, and the time spent during the procedure. We also endeavored to determine the importance of retroperitoneal air and its most appropriate clinical management. Twenty-one consecutive patients who had undergone ERCP with sphincterotomy had abdominal computed tomography (CT) examinations within 24 h after completion of the procedure. The CT findings were unknown to the clinicians, and none of the patients received postprocedural antibiotics. Six (29%) of 21 patients exhibited CT findings of retroperitoneal air. All six patients had uneventful postprocedural courses, and none had abnormal clinical signs or symptoms. The occurrence of retroperitoneal air was not influenced by the presence of hyperamylasemia, the duration of the procedure, or the length of the sphincterotomy. Retroperitoneal air is not an uncommon finding after ERCP with sphincterotomy. Moreover, the finding of retroperitoneal air in the absence of physical findings, is not a cause for alarm and does not require surgical intervention.