Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٣٢
the duodenal wall. Over time, the attenuation of the fluid decreases and a
pseudocapsule may form (Hahn et al., 1986).
3- Perforation:
Three distinct types of perforations have been described: guidewire-
induced perforation, periampullary perforation during sphincterotomy,
and perforation at a site remote from the papilla (Howard et al., 1999).
Prompt recognition of periampullary perforation and treatment with
aggressive biliary and duodenal drainage (by means of nasobiliary and
nasogastric tubes) coupled with broad-spectrum antibiotics can result in
clinical resolution without the need for operative intervention in up to
86% of patients.Risk factors for perforation include the presence of a
Billroth II partial gastrectomy, the performance of a sphincterotomy, the
intramural injection of contrast, duration of procedure, biliary stricture
dilation, and SOD (Enns et al., 2002).
Free retroperitoneal air has been seen in 29% of asymptomatic
patients on a CT scan obtained within 24 hours of the procedure. This
finding may occur due to insufflation of air into the duodenum for
endoscopy, which can lead to pneumatosis and extraluminal air
(Genzlinger et al., 1999). Pneumatosis can also occur with misdirection
of the catheter tip during duct cannulation and submucosal injection of
contrast material and air (Kuhlman et al., 1989).
The quantity of air seen is due to continued endoscopic insufflation
of air after the injury has occurred (Zissin et al., 2000). Patients with only
evidence of free air usually recover with conservative treatment, which
consists of bowel rest and antibiotics (Stapfer et al., 2000). However,
infection of bile and leakage of fluid through the perforation in cases of
failed biliary drainage correlate with increased morbidity (Scarlett et al.,
1994).