Introduction:

Duodenal perforation is an infrequent complication of ERCP, due to the heterogeneity of perforations there is no consensus for its treatment.

Clinical case:

Patient with choledocholithiasis, who underwent ERCP, identifying contrast medium leakage during the procedure, subsequently presenting massive subcutaneous emphysema, successfully treated with conservative management.

Discussion:

Perforation as a complication of endoscopic procedures, have a low incidence, among the associated risk factors, are the use of precut.

Conclusions:

Subcutaneous emphysema occurs infrequently in patients with perforation, conservative treatment will depend on the type of injury.