Table II. Surgical management of the peri-ampullary perforation group.

Patient no./age/sex	Time to diagnosis/surgery	Presentation	Radiological findings	Surgical findings and management	Length of stay (days)
1/58/F	2/2 days	Peritonitis, pancreatitis, leukocytosis	Large retro-peritoneal fluid collection on CT	Retroperitoneal fluids, bile stain and sealed perforation. Drainage of retroperitoneum. Re-operation on POD 1: duodenostomy, sphincterotomy site sutured, T-tube, duodenostomy tube, JP drains	18, death from sepsis
2/77/M	Intra-ERCP/9 h	No pain	No retroperitoneal air or fluid	Bile-stained retroperitoneum, no perforation identified. Cholecystectomy, cholangiogram, CBDE, transduodenal sphincterotomy to remove CBD stone	21
3/75/M	20 h at 2nd ERCP/28 h	Severe abdominal pain, afebrile, leukocytosis	UGI study showed retro-peritoneal perforation at 22 h	Bile stain, no perforation identified. Cholecystectomy, and drainage of retroperitoneum. Re-operation on POD 30 for continuing sepsis. Drainage of retroperitoneum, duodenostomy tube, gastrostomy tube	54, death from sepsis
4/31/F	25 h/36 h	Severe abdominal pain, afebrile, pancreatitis	Large retroperitoneal air and fluid collection on CT at 25 h	Bile stain, perforation not identified. Cholecystectomy, T-tube, feeding J-tube, drainage of retroperitoneum. Repeated percutaneous drainage of intra-abdominal abscess, and 2nd OR on POD 27 for open drainage of abdominal abscess	60
5/69/M	2 days/28 days	Mild abdominal pain, leukocytosis, febrile	Retroperitoneal air, liver abscess on CT on day 2. Normal UGI study on day 7	Subhepatic abscess, which was drained at OR. Repeat ERCP on day 48 revealed pus in CBD, sphincterotomy and biliary stent placed	80, death from sepsis