Complications and expected imaging findings after endoscopic retrograde cholangiopancreatography

Figure 15  Stapfer type IV perforation. A: Axial early post-endoscopic retrograde cholangiopancreatography contrast-enhanced computed tomography (CT); B: Axial contrast-enhanced CT on day 7 after endoscopic retrograde cholangiopancreatography. The 76-year-old patient who underwent sphincterotomy and placement of a plastic stent presented with mild abdominal pain and a slight elevation in serum amylase following the procedure. Despite the absence of intra-procedural suspicion and no clinical findings suggestive of perforation, free air was observed on CT in the right anterior pararenal and paraduodenal spaces (blue arrows). The patient was managed conservatively. A follow-up CT scan on day 7 demonstrated resolution of the free air. The patient’s clinical and laboratory findings were consistent with this benign course.