Introduction: ERCP (endoscopic retrograde cholangiopancreatography) with and without endoscopic sphincterotomy has become a worldwide common procedure in the era of interventional management of biliopancreatic disorders. Although considered as a safe procedure, it carries fatal complications, associated with significant mortality. Common complications are pancreatitis, cholangitis, bleeding, and perforation.

Patients and Methods: Patients who performed ERCP and complicated with perforation were included in the study. Study variables included indication for ERCP, presentation at the time of surgical admission, diagnostic procedures, time to diagnose, site of injury, management, duration of hospital stay, postoperative morbidity and its management and survival.

Results: Between January 2012 and December 2015, a total of 612 ERCPs were performed at the gastrointestinal endoscopy center. Nine iatrogenic duodenal perforations (1.47%) were identified (3 male, 6 female). The mean patient age was 47 years. Injury was suspected during the procedure in three patients; it passed unnoticed in six patients. The decision to conserve or operate was based on clinical and radiological backgrounds. Conservative management preferred in two patients and operative intervention was indicated in seven patients. The two patients treated conservatively were recovered. One of the seven patients underwent surgery died after exploratory laparotomy. The other survived six, underwent multiple procedures and had long inpatient stays. The mortality rate in patients treated surgically was 14.3% (1 of 7 patients). The overall mortality rate was 11.1% (1 of 9 patients).

Conclusion: Iatrogenic duodenal perforations are associated with significant complications and mortality. Diagnosis may be easy, but attention must be paid to it. Immediate surgical evaluation and close monitoring is needed. Early perforations may be recovered with conservative management. Most intraperitoneal perforations need surgery. The time between the onset of perforation and the surgical interference is of great importance. Mortality increased dramatically with delayed surgical management.