Background: One of the feared complications of ERCP is perforation. The incidence of visceral perforation was reported 0.5%.Early recognition is vital for a successful treatment of this rare complication.
Case Reports: We present two cases of retroperitoneal perforation secondary to endoscopic sphincterotomy with clinical and imaging findings. These patients managed with conservative treatment at Izmir Ataturk Training Hospital, Department of Surgery, Izmir, Turkey.
Conclusions: The incidence of endoscopic sphincterotomy related perforations is less than 1% (1,2). Factors which increase the risk of a perforation during endoscopic sphincterotomy includes advanced
age, longer duration of the procedure, presence of stricture,presence of ductal stone disease and peripapillary diverticula.

Keywords: endoscopic sphincterotomy, ERCP, duodenal perforation, retroperitoneal air leak