Zhou GYJ, Hu JL, Wang S, Ge N, Liu X, Wang GX, Sun SY, Guo JT. Delayed perforation after endoscopic resection of a colonic laterally spreading tumor: A case report and literature review. World J Clin Cases 2020; 8(16): 3608-3615 [PMID: 32913871 DOI: 10.12998/wjcc.v8.i16.3608]
Corresponding Author of This Article
Si-Yu Sun, MD, PhD, Chief Doctor, Director, Professor, Department of Gastroenterology, ShengJing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. sunsy@sj-hospital.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ge-Yu-Jia Zhou, Jin-Long Hu, Sheng Wang, Nan Ge, Xiang Liu, Guo-Xin Wang, Si-Yu Sun, Jin-Tao Guo, Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Zhou GYJ and Hu JL prepared the case and contributed to manuscript drafting; Zhou GYJ and Guo JT analyzed the case and reviewed the literature; Sun SY and Guo JT contributed to study concept and manuscript drafting; Wang S, Ge N, Liu X, and Wang GX contributed to manuscript revision for important intellectual content; all authors gave final approval for the version to be submitted.
Supported byNatural Science Foundation of Liaoning Province, No. 20170541024; and Shengjing Free Researcher Project Foundation, No. 201702.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si-Yu Sun, MD, PhD, Chief Doctor, Director, Professor, Department of Gastroenterology, ShengJing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. sunsy@sj-hospital.org
Received: April 8, 2020 Peer-review started: April 8, 2020 First decision: April 28, 2020 Revised: April 29, 2020 Accepted: July 14, 2020 Article in press: July 14, 2020 Published online: August 26, 2020 Processing time: 138 Days and 22.8 Hours
Abstract
BACKGROUND
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely used for the treatment of early gastrointestinal cancer. Endoscopic piecemeal mucosal resection (EPMR) is derived from the combination of EMR and ESD. Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication, sometimes requiring surgery. There are some associated risk factors, including patient- (location, diameter, and presence of fibrosis) and procedure-related factors. Early recognition and timely treatment are crucial for its management.
CASE SUMMARY
We report a case in which delayed perforation with peritonitis was treated using endoscopic closure. A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature. Fifteen hours after endoscopic resection, peritonitis caused by delayed perforation occurred and gradually aggravated. Conservative treatment was ineffective and no obvious perforation was observed. After timely endoscopic closure, the patient was discharged on postoperative day 4.
CONCLUSION
In occasion of localized peritonitis aggravating without macroscopic perforation, endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.
Core tip: We report a case in which delayed perforation occurred 15 h after colonic endoscopic resection of a laterally spreading tumor in the colonic hepatic curvature. Peritonitis aggravated progressively without macroscopic perforation and conservative treatment had no effect. Micro-perforation was successfully closed under endoscopy with clips to avoid worse complications and surgical intervention.
