Introduction.

Because it is a minimally invasive procedure, endoscopic retrograde cholangiopancreatography (ERCP) is the most widely used procedure for the management of biliary lithiasic pathology. However, it can present complications that compromise the life of the patient.

Clinical case.

A 63-year-old male patient is taken to ERCP for a giant recurrent choledocholithiasis. During the procedure presented a massive air dissection with bilateral tension pneumothorax, secondary to a duodenal perforation, which led to a bilio-retroperitoneal fistula. It was treated conservatively with adequate evolution.

Discussion.

Few cases of pneumothorax have been described as a complication of ERCP. This is considered to be the first published case of tension pneumothorax successfully managed conservatively.

Conclusion.

Early diagnosis of air dissections is the only independent predictor that could change the clinical course of this pathology, and its management will depend on the expertise of the surgeon and the clinical status of the patient.

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