Porous diaphragm syndrome after ERCP in a patient with bile duct stricture.

A 24-year-old man was admitted for evaluation of progressive jaundice. ERCP revealed a stricture in the distal common bile duct. Brushing cytology from the strictured area was employed and subsequently 10 French plastic stent was inserted for palliation of jaundice. After withdrawal of duodenoscope, the patient developed tachypnea and dyspnea. In the following minutes, subcutaneous emphysema extending from his face to his lower extremities was observed. Thoracoabdominal computed tomography revealed bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema (Figures 1, 2). Due to progressive dyspnea and tachypnea and increase in the size of bilateral pneumothorax, bilateral thoracic tubes were immediately inserted. The symptoms of the patient and radiographic findings were ameliorated after the placement of the chest tubes. At laparotomy, no perforation was identified. Microperforation around the strictured area remained a high possibility for the occurrence of diffuse emphysema. Chest tubes were removed on the third day of hospitalization. The patient responded to the treatment with dramatic physical and radiographic improvement and was discharged on the eighth day.