Duodenal perforation treated with LAMS: case report

CASE REPORT: A 61-year-old female patient with a history of bulbous stenosis secondary to a duodenal ulcer, previously treated with balloon dilation, underwent another dilation procedure due to recurrent stenosis. Although asymptomatic, she admitted to poor adherence to proton pump inhibitor therapy. During the upper gastrointestinal endoscopy (EGD), a pinpoint stenosis was noted at the duodenal bulb, preventing passage of the endoscope. Balloon dilation to 15-18 mm was performed; however, a mucosal defect with exposed muscle fibers was subsequently identified, indicating a perforation, which was confirmed by fluoroscopy showing extraluminal leakage [1].

Attempts to close the perforation with hemostatic clips and OTS-Clip failed, prompting the placement of a LAMS. A CT scan confirmed pneumoperitoneum and correct stent positioning. The patient was hospitalized and managed with supportive care, resuming a liquid diet by the third day. She was discharged on a soft diet after five days and underwent a follow-up EGD three weeks later, which confirmed complete mucosal healing post-stent removal.

CONCLUSION: Iatrogenic duodenal perforations are rare but associated with high morbidity and mortality. Early intervention is critical, with studies indicating a 95% success rate when treated promptly. In this case, endoscope instability complicated clip placement, so a LAMS was chosen, avoiding surgery and potential treatment delays. The LAMS design reduces migration risk, making it a viable alternative for duodenal perforations.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Putnam, Tyler MD1; Ansari, Zaid MD1; Reddymasu, Savio MD1; Vyas, Neil MD1 S2786 Iatrogenic Duodenal Perforation Repaired With a Lumen Apposing Metal Stent The American Journal of Gastroenterology. 115 pS1456-S1457 2020.