1%) Pyloric exclusion and gastro-jejunostomy CBD exploration T-tube Hepatico-jejunostomy Bowel decompression Kalyani et al. 2005  1 Jejunal
serosal patch Not required Nil required >15 0 (0%) Melita et al. 2005  1 Nil required CT-guided abscess drainage Nil required Not specified 0 (0%) Wu et al. 2006  10 Primary repair Drain placement Cholecystectomy 31.4 4 (40%) Omental patch Open abscess drainage CBD exploration Duodenostomy Percutaneous abscess drainage Cholecysto-jejunostomy Fatima et al. 2007  22 Primary repair Drain placement Choledocho-jejunostomy 16 3 (13.6%) Omental patch Knudson et al. 2008  12 Primary repair Drain placement Hepatico-jejunostomy 4.5 0 (0%) T-tube Open abscess drainage Omental patch Duodenostomy tube Gastrostomy Jejunostomy tube Pyloric exclusion Mao et al. 2008  3 Nil required Drain selleck chemicals placement Cholecystectomy 50 0 (0%) CBD exploration T-tube Angiò et al. 2009  1 Kocherization and primary repair Not described CBD exploration 23 0 (0%) Avgerinos et al. 2009  15 Primary repair Not described Choledocho-duodenostomy
42 3 (20%) Omental patch Pyloric exclusion Gastro-enterostomy Morgan et al. 2009  10 Primary repair gastrojejunostomy Drain placement Not available 1 (10%) Dubecz et al. 2012  4 Primary repair Not described BMN 673 nmr Hepatico-jejunostomy 23 0 (0%) T-tube Ercan et al. 2012  13 Primary repair Percutaneous abscess drainage Cholecystectomy 10.2 6 (46.2%) Pyloric exclusion
Open abscess drainage CBD exploration Gastro-enterostomy T-tube Caliskan et al. 2013  9 Primary repair Not described CBD exploration 22.6 4 (44.4%) Duodenostomy T-tube Pyloric exclusion, gastro-jejunostomy Pancreatico-duodenectomy The other important issue to contend with in duodenal injuries is the management of retroperitoneal necrosis or sepsis. In most cases where laparotomy is performed, some degree of debridement and placement of drains is undertaken. This may be all that can be done if primary duodenal repair is not feasible, or the perforation cannot be localized amid the devitalized tissue. As illustrated by our own case series, repeated drainage 5-Fluoracil cost procedures are often necessary if signs of recurrent sepsis develop. As has been noted by other authors,  males are also at risk of developing sepsis of the inguinoscrotal tract. Percutaneous drainage of any recurrent collections may be attempted using radiological guidance, unless the semi-solid nature of the debris necessitates an open approach. The technique of video-assisted retroperitoneal debridement,  as validated for infected necrotizing pancreatitis, may be of use, but there have been no reports of its application in this context. Conclusion Retroperitoneal necrosis due to duodenal perforation is a rare but serious complication of ERCP.