Gas spread following endoscopic sphincterotomy: Challenging diagnosis and management: A case reports

INTRODUCTION AND IMPORTANCE: Subcutaneous emphysema, pneumomediastinum and pneumoperitoneum simultaneously are a rare complication of endoscopic retrograde cholangiopancreatography (ERCP) that usually indicates free perforation to the peritoneal cavity or the retroperitoneal space. CASE PRESENTATION: We report an unusual case of a subcutaneous emphysema, pneumomediastinum and pneumoperitoneum following an ERCP for removal of a common bile duct stone. There was no radiological evidence of peritoneal or retroperitoneal perforation. CLINICAL DISCUSSION: This complication seems to be relative to duodenal perforation. However, hypotheses of transdiaphragmatic pressure effects and gas diffusion within the mucosa are discussed in the literature pneumomediastinum and pneumoperitoneum, must be recognized, because it is benign and needs exceptionally surgical or radiological intervention. Management of this adverse event depends on type of perforation and clinical presentation. CONCLUSION: ERCP has facilitated innovative diagnosis and treatment of pancreatobiliary tract diseases. Nevertheless, some complications may occur such gas diffusion in the peritoneal cavity or the retroperitoneal space with or without perforation. Our case our case illustrates such incidents could be benign, self-limited and need no intervention.