open access

Vol 19, No 1-2 (2017)
Case reports
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Endoluminal treatment of an iatrogenic colon perforation after ESD of a sigmoid tumor- case report

Tomasz Klimczak, Jerzy Klimczak, Piotr Jurałowicz
Chirurgia Polska 2017;19(1-2):22-27.

open access

Vol 19, No 1-2 (2017)
Case reports

Abstract

Neoplastic lesions of the colon, adenomas included, are a rising medical issue. Due to a rapid advancement of flexible GI endoscopy we are can screen our patients more effectively and provide a more accurate treatment. Thanks to a novel technique of endoscopic submucosal dissection (ESD), lateraly spreading tumors (LST), including cancers, can be safely resected. However, despite the initial awe, it came to notice, that this technique is not without flaws. Perforation, right after bleeding, is the most common complication, with a occurence rate of 4,2%. Despite the severe nature of this complication, it can sometimes be managed endoscopicly without the need of a complicated surgical procedure or diverting a stoma.             The aim of this study is to present the case of 75-year-old patient who was admitted to our institution with tree tumors located in the sigmoid colon and rectum in order to perform ESD. Two lower lesions were removed without complications. During the dissection of the tumor located near the recto-sigmoid flexure, we encountered a large perforation site (about 25mm wide). Using an Endo-Loop and several hemostatic clips we created a circumferential "suture" that sealed the colon wall defect completly. The patient's recovery was uneventful- he was discharged in the 8th day after the procedure. Histopathological examination showed high-grade dysplasia in the lesions and confirmed a complete excition. An endoscopic follow-up was performed 90 days after the procedure showing that the defect was fully healed.             Due to a novel approach in treatment of an iatrogennic perforation, the patient avoided a mutliating, urgent surgery, which, apart from additional suffering, causes a decrease in the quality of life and risks of subsequent complications

Abstract

Neoplastic lesions of the colon, adenomas included, are a rising medical issue. Due to a rapid advancement of flexible GI endoscopy we are can screen our patients more effectively and provide a more accurate treatment. Thanks to a novel technique of endoscopic submucosal dissection (ESD), lateraly spreading tumors (LST), including cancers, can be safely resected. However, despite the initial awe, it came to notice, that this technique is not without flaws. Perforation, right after bleeding, is the most common complication, with a occurence rate of 4,2%. Despite the severe nature of this complication, it can sometimes be managed endoscopicly without the need of a complicated surgical procedure or diverting a stoma.             The aim of this study is to present the case of 75-year-old patient who was admitted to our institution with tree tumors located in the sigmoid colon and rectum in order to perform ESD. Two lower lesions were removed without complications. During the dissection of the tumor located near the recto-sigmoid flexure, we encountered a large perforation site (about 25mm wide). Using an Endo-Loop and several hemostatic clips we created a circumferential "suture" that sealed the colon wall defect completly. The patient's recovery was uneventful- he was discharged in the 8th day after the procedure. Histopathological examination showed high-grade dysplasia in the lesions and confirmed a complete excition. An endoscopic follow-up was performed 90 days after the procedure showing that the defect was fully healed.             Due to a novel approach in treatment of an iatrogennic perforation, the patient avoided a mutliating, urgent surgery, which, apart from additional suffering, causes a decrease in the quality of life and risks of subsequent complications
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Keywords

Endoscopic submucosal dissection (ESD), iatrogenic bowel perforation, lateraly spreading colon tumor (LST), colon cancer

About this article
Title

Endoluminal treatment of an iatrogenic colon perforation after ESD of a sigmoid tumor- case report

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 19, No 1-2 (2017)

Pages

22-27

Bibliographic record

Chirurgia Polska 2017;19(1-2):22-27.

Keywords

Endoscopic submucosal dissection (ESD)
iatrogenic bowel perforation
lateraly spreading colon tumor (LST)
colon cancer

Authors

Tomasz Klimczak
Jerzy Klimczak
Piotr Jurałowicz

References (6)
  1. Oficjalna strona internetowa Krajowego Rejestru Nowotworów. http://onkologia.org.pl/nowotwory-zlosliwe-jelita-grubego-c18-21.
  2. Orłowska J, Kiedrowski M. Gruczolaki ząbkowane i polipowatość hyperplastyczna, a rak jelita grubego. Post Nauk Med. 2009; 2: 111–117.
  3. Akintoye E, Kumar N, Aihara H, et al. Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis. Endosc Int Open. 2016; 4(10): E1030–E1044.
  4. Paspatis GA, Dumonceau JM, Barthet M, et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2014; 46(8): 693–711.
  5. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47(9): 829–854.
  6. Schmidt A, Meier B, Caca K. Endoscopic full-thickness resection: Current status. World J Gastroenterol. 2015; 21(31): 9273–9285.

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