Introduction
The over-the-scope clip (OTSC) (Ovesco Endoscopy GmbH, Tübingen, Germany), designed
for tissue approximation, is already recommended as first-line endoscopic treatment
for endoscopic acute iatrogenic perforation [1]. To the best of our knowledge, no data regarding gastrointestinal traumatic, not
iatrogenic, perforation repaired with the use of OTSC, are available.
Case report
A 16-year-old girl was referred to the emergency room for copious rectal bleeding
and secondary syncope, due to violent trauma. Computed tomography (CT) scan and subsequent
colonoscopy revealed a voluminous pelvic hematoma and a 35 – to 40-mm irregular full-thickness
defect, located in the posterior rectal wall, about 30 mm from the dentate line ([Fig. 1]).
Fig. 1 35- to 40-mm irregular full-thickness defect of the posterior rectal wall.
Because of the lesion’s features and the acute setting, an OTSC was placed (12 /6 mm,
traumatic type) using the OTSC twin grasper (Ovesco Endoscopy GmbH, Tübingen, Germany)
([Fig. 2]). This auxiliary device has two jaws which can be opened separately, allowing better
gaping edges approximation.
Fig. 2 Edges approximation with OTSC twin grasper.
The entire procedure was performed under deep sedation, using CO2 insufflation [Video 1].
Video 1 Full-length video showing the entire successful repair of wide traumatic rectal perforation
using OTSC
The endoscopic treatment was effective, as confirmed after contrast medium injection
and CT scan.
A Few days later, second endoscopic look confirmed complete sealing of the defect
and the patient was discharged home ([Fig. 3]).
Fig. 3 Complete sealing of the defect.
Conclusion
In conclusion, OTSC with a twin grasper can successfully treat wide traumatic rectal
perforation, avoiding major surgery with definitive or temporary stoma, especially
in a young patient.
