iarjmcrIARJMCRIARJMCR2709-3220https://doi.org/10.47310/iarjmcr.2021.v02i02.022Generalized Peritonitis Due to Stent Migration after Endoscopic Retrograde Cholangiopancreatography:Early Diagnosis for Better Clinical OutcomeAndiMuhammad Reva AgustusMunruIdaBagus Budhi SuryaAdnyanaGastroduodenal perforation is a serious condition that is deadly if not promptly recognized and treated. One possible cause of perforation is iatrogenic, including endoscopic retrograde cholangiopancreatography (ERCP) procedures. The classic presentation of gastroduodenal perforation is sudden intense abdominal pain, accompanied with tachycardia and abdominal rigidity, along with subdiaphragmatic free air on plain radiograph. However, this classic presentation does not always occur. We report a 73-year-old man with progressive abdominal pain. He had a history of obstructive jaundice treated with stenting via ERCP. Upon examination, the abdomen was tender with generalized guarding, although imaging studies were inconclusive. Exploratory laparotomy revealed a duodenal perforation, out of which protruded the biliary stent from one year prior. The stent was extracted and the perforation repaired. ERCP-related duodenal perforation is an uncommon potentially life threatening complication. The signs and symptoms may be nonspecific especially in elderly patients. Sound judgment and prompt treatment are essential to reduce morbidity and mortality.