Background

The procedure of endoscopic retrograde cholangiopancreatography (ERCP) poses a variety of risks including pancreatitis, hemorrhage, infection, and perforation. While perforation remains a rare complication, it carries a significant burden of morbidity and mortality. In patients who have undergone Roux-en-Y gastric bypass, there is a need to perform this procedure given the elevated risk of gallstone formation post-operatively. While perforation remains a relatively rare event in this unique patient population, it is a complication we need to be prepared for.We present a case of a 69 year old woman with a history of Roux-en-Y gastric bypass and previous laparoscopic cholecystectomy who required laparoscopic assisted ERCP for common bile duct stone retrieval. During the procedure, she suffered iatrogenic perforation of the lateral duodenum (Stapfer Grade I). Here we present a video showing intraoperative steps of immediate laparoscopic primary repair with omentopexy and gastrostomy tube insertion. The patient tolerated the procedure well in the immediate postoperative period. She underwent a short course of antibiotics for retained peri-duodenal abscess. She was discharged home and has since had her surgical drain and gastrostomy tube removed.