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DOI: 10.1055/s-0034-1365796
Delayed successful treatment of iatrogenic colon perforation using an over-the-scope clip
Publication History
Publication Date:
06 June 2014 (online)
Over-the-scope clip closure of iatrogenic gastrointestinal tract perforations has been successfully demonstrated, and is usually performed in the immediate peroperative setting [1] [2]. We report the first case, to our knowledge, of delayed successful treatment of an iatrogenic colon perforation using an over-the-scope clip.
An 80-year-old woman underwent routine colonoscopy. Her medical history was unremarkable apart from unexplained thrombocytopenia (40 000 platelets/dL). During endoscopy, a perforation occurred at the level of the sigmoid junction with the left colon ([Fig. 1]). At that time, after multidisciplinary discussion, and in view of the successful colonic preparation and the thrombocytopenia, a mini-invasive endoscopic treatment was proposed (the patient being on antibiotics). Two and a half hours later the patient was transferred to our unit for an attempt at clip closure. Using a gastroscope and CO2 insufflation, a 7-mm perforation orifice was visualized. An OTSC 11/6 t clip (Ovesco Endoscopy GmbH, Tübingen, Germany) was then delivered, with aspiration of the edges of the orifice ([Fig. 2], [Fig. 3]). Contrast medium study through the endoscope performed at that time did not show any fluid extravasation ([Fig. 4]).
The day after the procedure, the patient presented localized peritoneal irritation and fever (38 °C). Lab tests showed no hyperleukocytosis, but the C-reactive protein level had increased to 204 U/L. Spiral CT with bowel opacification performed then confirmed a sealed clip closure with no free fluid or air in the peritoneal cavity ([Fig. 5]). The patient was kept fasting until bowel transit was re-established 2 days later. She was symptom-free by the postoperative third day. On day 5, she was discharged from the hospital. She is clinically well and symptom-free.
Delayed treatment of an iatrogenic colonic perforation with an over-the-scope clip is a feasible and effective technique that should be considered by expert endoscopists. However, the peritoneal cavity may become contaminated during the delay between perforation and definitive treatment.
Endoscopy_UCTN_Code_TTT_1AQ_2AG
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References
- 1 Donatelli G, Vergeau BM, Dritsas S et al. Closure with an over-the-scope-clip allows therapeutic ERCP to be safely performed after acute duodenal perforation during diagnostic endoscopic ultrasound. Endoscopy 2013; 45: E392-393
- 2 Dìez-Redonod P, Bianco JL, Lorenzo-Pelayo S et al. A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco clip and omental patch. Rev Esp Enferm Dig 2012; 104: 550-552