내시경적 유두괄약근 절개술후 발생한 기종격증 및 피하기종

Perforation, bleeding, cholangitis, and pancreatitis are common complications of endoscopic sphincterorny(EST) that is considered a common effective method for treatment of distal bile duct obstruction and removal of bile duct stones. Perforation of duodenutn complicates endoscopic sphincterotomy in approximately 1% of cases. But, retroperitoneal, mediastinal and subcutaneous emphysema are very rare complications of endoscopic sphincterotomy. A 50-year-old woman was admitted to our hospital due to right upper quadrant abdominal pain for 1 week. An ERCP revealed markdly dilated commom bile duct and rnultiple ductal filling defects. For removal of' stones, EST was performed with pull type papillotome. About 1 hour later after procedure, she complained of chest pressure, shortness of breath and abdominal distension. The chest X-ray film revealed a pneumomediastinum, segmental atelectasis of left lower lung fields and subcutaneous emphysema. The simple abdominal X-ray showed mottled air densities in the right midabdomen and crescentic air densities in the right perirenal space. We report on a rare case of retroperitoneal duodenal perforation, pneumomediastinum and subcutaneous emphyserna following endoscopic sphinctero- tomy, in a patient with common bile duct stones. (Korean J Gastroenterol 1997; 29:399-403)