Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective procedure for the diagnosis and treatment of the pancreatic and extrahepatic biliary tract diseases, it is still related with several complications. A female patient who underwent an ERCP with sphincterotomy developed massive subcutaneous emphysema along with pneumomediastinum and pneumoperitoneum. Although mild respiratory distress occurred, based on the absence of intaabdominal leakage of gastrografin, the patient was managed conservatively. In conclusion, the retroperitoneal air collection related to ERCP is well recognized even in the absence of obvious perforation and may spread to adjacent areas, causing serious complications.