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Pneumothoraces were sometimes diagnosed only after hospital discharge (14%). Eighteen patients underwent surgical therapy with drainage, repair and/or bypass. Conservative treatment included antibiotics and bowel rest. Most pneumothoraces were drained; 14% resolved without pleural drainage. Overall mortality was 4%. The mean hospital stay was 9.8 days. CONCLUSIONS A post-ERCP pneumothorax should be considered when subcutaneous emphysema, cardiovascular instability or respiratory distress occurs. Thoraco-abdominal computed tomography facil