Traditionally, duodenal perforations hove been managed surgically; however, recently, management has shifted to a 
more selective approach. 
The authors reviewed retrospectively, from January 1998 to June 2001, at the endoscopy units of El-Minia & Sohag 
University Hospitals, identified 12 instances of duodenal perforations related to EPCP, a rate of 2.5% of total procedures 
done. Charts were reviewed for the following: ERCP findings, mechanisms of injury, clinical presentation of perforation, 
diagnostic methods, time to diagnosis, methods of management, surgical procedures and outcome. 
Twelve patients had a duodenal perforation. Eight patients were initially managed conservatively. Two of the eight 
patients failed non-surgical management and a decision to operate was delayed to end fatally. Four patients were managed initially by surgery and one patient had a delayed surgical management due to missed diagnosis with fatal outcome on the 4th post - operative day. 
Clinical and radiographic features of ERCP-related duodenal injuries can be used to categorize patients into surgical or 
non-surgical groups. A selective management scheme is proposed.