A novel surgical technique for repairing duodenal and bile duct perforations following endoscopic retrograde cholangiopancreatography

Duodenal perforation (DP), though rare, is a severe complication of Endoscopic retrograde cholangiopancreatography (ERCP) with high mortality rates. This report introduces a novel surgical approach for repairing a complex combined bile duct and duodenal perforation. A 37-year-old male with recurrent pyloric stenosis and choledocholithiasis, previously treated with multiple procedures, presented with gastric outlet and bile duct obstruction. Following a complex ERCP, he developed a large combined duodenal and bile duct perforation requiring urgent surgical intervention. A 40% circumferential duodenal perforation combined with bile duct perforation was repaired using a novel approach: a vascularized isolated distal gastric pouch was created and anastomosed to the duodenal and bile duct defects. A Roux-en-Y gastrojejunostomy was performed, and the patient recovered in stable condition. When traditional reconstruction is not feasible for DP, an isolated, vascularized distal gastric pouch offers a less invasive alternative and reduces the risk of morbidity.