Grey-Turners sign following iatrogenic duodenal perforation

Description

A 45-year-old man presented with a 6-hour history of acute epigastric pain radiating to the back, following endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy and biliary stenting for obstructive jaundice secondary to choledocholithiasis.

The patient was markedly tender in the epigastrium and right flank, with the pain becoming progressively worse over the following 48 hours. A CT scan of the abdomen and pelvis was performed, revealing a normally enhancing pancreas with pockets of free air and fluid adjacent to the second part of the duodenum and in the retroperitoneum, extending to the right flank, an associated perinephric collection and extensive peritoneal fat stranding. Inflammatory markers were raised alongside a moderately elevated amylase, with a clotting screen within normal limits and stable serial haemoglobin levels. These findings were in keeping with a posterior duodenal perforation (figure 1A,B).

Figure 1

Axial (A) and coronal (B) CT images demonstrating the retroperitoneal collection containing...

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