# Laparoscopic Repair of Iatrogenic Endoscopic Retrograde Cholangiopancreatography (ERCP)-Induced Duodenal Bulb Perforation in an Elderly Patient With Concomitant Type IV Hiatal Hernia: A Case Report

## TL;DR

An elderly patient with a hiatal hernia had a rare ERCP complication repaired successfully with laparoscopic surgery.

## Contribution

Demonstrates successful laparoscopic repair of ERCP-induced duodenal perforation in a geriatric patient with a type IV hiatal hernia.

## Key findings

- Laparoscopic repair was effective for ERCP-induced duodenal perforation in a 93-year-old with a type IV hiatal hernia.
- Prompt recognition and minimally invasive intervention led to successful recovery despite complex anatomy.
- Procedure highlights safety and efficacy of laparoscopic repair in high-risk geriatric patients.

## Abstract

Duodenal perforation is a rare but serious complication of endoscopic retrograde cholangiopancreatography (ERCP), particularly when anatomical distortions, such as large hiatal hernias, complicate endoscopic access. This case describes a 93-year-old patient with a type IV hiatal hernia who suffered an iatrogenic duodenal injury during a procedure for acute cholangitis. Due to the size of the defect and the patient's complex anatomy, an emergent laparoscopic repair was performed to reduce the hernia and repair the perforation. The patient's successful recovery highlights that prompt recognition and minimally invasive surgical intervention can be safe and effective, even in geriatric populations where anatomical challenges such as large hiatal hernias increase procedural risk.