Mistake during endoscopic snare papillectomy

Abstract Text A 74 year-old lady underwent endoscopic papillectomy. At the end of en-bloc resection severe bleeding occurred. A 25-gauge needle was advanced to perform a submucosal injection of diluted epinephrine (1:10000). The presence of abundant amount of blood in the duodenum reduced the visibility and an excessive pression on the needle tip led to duodenal wall perforation. Two 16 mm endoclips were placed and promptly closed the duodenal wall defect. The patient was referred for urgent CT scan, confirming the presence of free air in the retroperitoneum. After 7 days a control CT scan showed reduction of the retropeumoperitoneum without collections. Clinical course was uneventful. The patient is free of recurrence after 2 year.