Retroperitoneal perforation after endoscopic sphincterotomy: the dilemma of management

Retroperitoneal perforation is an occasional complication of endoscopic retrograde cholangiopancreatography, which is expected to increase in frequency. The outlook for patients with this complication is good. Conservative, nonsurgical management is suitable for most patients. The main goal is to achieve adequate drainage of the common bile duct which can be done endoscopically. Despite persistent obstruction an initial period of conservative management is usually appropriate. Surgical intervention should be withheld until the patient's condition is becoming worse, or until a complication such as localized retroperitoneal abscess is recognized.