mangement of ERCP related duodenal operations

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management of ERCP related complications like duodenal perforations-- ,suspected during ercp procedure in an elderly pt  with underlying obstructive jaundice --  is CT scan gold standard1. to establish / exclude diagnosis or suspicion-2.to classify the  grade and magnitude of problem3.to direct where to operate where to stop;4where to stop ;where to operate-5.is pneumoperitoneumor air in retroperitoneum  or collection in absence of peritonitis or sepsis an indication for laparotomy 5.apart from draining of torn duodenum or /sealing it by suture or patch  --how much is too  much to deal with basic underlying pathology--guidelines from esteemed surgeons

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