Endoscopic Treatment of a Late Diagnosed Staphylococcal Delilinol Perforation. These are our disclosures. Delilinol perforation is a rare but severe complication of ERCP with an incidence rate of 0.34%. When a retroperitoneal collection ensues, adequate drainage is prompted due to mortality rates of up to 20%. Staphylococcal delilinol lesions are treated in a conservative manner but may require a surgical approach in cases with a late diagnosis, systemic compromise, or when there is a collection. In this case, we show that endoscopic treatment provides a viable and safer approach to patients with late diagnosed Staphylococcal delilinol lesions and retroperitoneal collections. We have a 26-year-old female with a history of laparoscopic cholestectomy and ERCP due to residual cholestical stones. Two weeks later, she was admitted with abdominal pain, fever, and elation of acute phase reactants. An abdominal CT scan shows an air-liquid collection in the retroperitoneum with a volume of 42.8 cc. Due to a recent history of involvement of the biliary ducts, an ERCP is decided in search of bile duct perforation. In the ERCP, we find a punctiform defect with pus oozing from it, lateral to the papilla. A chalangiogram is shown to have no leaks and a stream biliary catheter is introduced. We channel the defect and irrigate it with solution until no debris comes out and introduce a contrast agent. Showing a collection with no communications, a double pigtail catheter is introduced without complications. Finally, a nasogenial feeding tube is placed to begin feedings. In the second session, a fully covered metallic stent is deployed in the second portion of the adenium and fixated with five endoscopic clips, three proximal and two distal, allowing oral feeding with a clear liquid diet. Four weeks later, a CT scan shows no remnants of the collection, the metallic stent is removed, and we remove the bubble pigtail catheter as well and prepare the area for closure. We close with argoplasma, or APC, with revitalizing the borders, and close with two 8mm endoscopic clips. Furthermore, a double active two-shoe clip is used to close the defect with the perlision of mucosal folds. In a one-month follow-up, an ARCP is made to remove the biliary stent showing a cholangiogram with no dilatation, friction, or leaks. In the next follow-up, the patient is shown with no more symptoms and is discharged from the service. In conclusion, endoscopic treatment of a late diagnosis after two deletions is a viable option. Endoscopic drainage of retroperitoneal collection is viable and safe. Endoscopic treatment can diminish costs and avoid the potential complications of a surgery.

endoscopic treatment

duodenal perforation

Staphylococcal infection

ERCP complication

non-surgical approach