1%) Pyloric exclusion and gastro-jejunostomy   CBD exploration T-tube   Hepatico-jejunostomy Bowel decompression         Kalyani et al. 2005 [26] 1 Jejunal

serosal patch Not required Nil required >15 0 (0%) Melita et al. 2005 [27] 1 Nil required FK506 clinical trial CT-guided abscess drainage Nil required Not specified 0 (0%) Wu et al. 2006 [18] 10 Primary repair Drain placement Cholecystectomy 31.4 4 (40%) Omental patch Open abscess drainage CBD exploration Duodenostomy Percutaneous abscess drainage Cholecysto-jejunostomy Fatima et al. 2007 [28] 22 Primary repair Drain placement Choledocho-jejunostomy 16 3 (13.6%) Omental patch     Knudson et al. 2008 [29] 12 Primary repair Drain placement Hepatico-jejunostomy 4.5 0 (0%) T-tube Open abscess drainage   Omental patch     Duodenostomy tube     Gastrostomy     Jejunostomy tube     Pyloric exclusion     Mao et al. 2008 [30] 3 Nil required Drain FRAX597 purchase placement Cholecystectomy 50 0 (0%) CBD exploration T-tube Angiò et al. 2009 [31] 1 Kocherization and primary repair Not described CBD exploration 23 0 (0%) Avgerinos et al. 2009 [19] 15 Primary repair Not described Choledocho-duodenostomy

42 3 (20%) Omental patch   Pyloric exclusion   Gastro-enterostomy   Morgan et al. 2009 [32] 10 Primary repair gastrojejunostomy Drain placement   Not available 1 (10%) Dubecz et al. 2012 [33] 4 Primary repair Not described buy JSH-23 Hepatico-jejunostomy 23 0 (0%) T-tube     Ercan et al. 2012 [21] 13 Primary repair Percutaneous abscess drainage Cholecystectomy 10.2 6 (46.2%) Pyloric exclusion

Open abscess drainage CBD exploration Gastro-enterostomy   T-tube Caliskan et al. 2013 [34] 9 Primary repair Not described CBD exploration 22.6 4 (44.4%) Duodenostomy   T-tube Pyloric exclusion, gastro-jejunostomy   Pancreatico-duodenectomy The other important issue to contend with in duodenal injuries is the management of retroperitoneal necrosis or sepsis. In most cases where laparotomy is performed, some degree of debridement and placement of drains is undertaken. This may be all that can be done if primary duodenal repair is not feasible, or the perforation cannot be localized amid the devitalized tissue. As illustrated by our own case series, repeated drainage Ureohydrolase procedures are often necessary if signs of recurrent sepsis develop. As has been noted by other authors, [41] males are also at risk of developing sepsis of the inguinoscrotal tract. Percutaneous drainage of any recurrent collections may be attempted using radiological guidance, unless the semi-solid nature of the debris necessitates an open approach. The technique of video-assisted retroperitoneal debridement, [42] as validated for infected necrotizing pancreatitis, may be of use, but there have been no reports of its application in this context. Conclusion Retroperitoneal necrosis due to duodenal perforation is a rare but serious complication of ERCP.