クリップによる内視鏡的穿孔部閉鎖術にて保存的に治癒し得た医原性大腸穿孔の４例

DOI 被引用文献2件 参考文献11件

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  • FOUR CASES OF IATROGENIC COLORECTAL PERFORATION SUCCESSFULLY TREATED BY CONSERVATIVE THERAPY WITH ENDOSCOPIC REPAIR USING A CLIPPING DEVICE

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We experienced 4 cases of iatrogenic colorectal perforation which were successfully treated by conservative therapy with endoscopic repair using a clipping device. In 2 cases (case 1, 2), perforations occurred during endoscopic mucosal resection for sessile polyps in the sigmoid colon, and the rectum, respectively. In another case (case 3), perforation was recognized during endoscopic submucosal dissection for a large sessile polyp in the transverse colon. In the remaining case (case 4), perforation happened in the sigmoid colon during diagnostic colonoscopy. The perforation sites were immediately closed in all cases using hemostatic clips. Abdominal puncture was required to reduce the pressure of the abdominal cavity in 2 of 4 cases. Plain abdominal X--rays showed free air in the intraperitoneal space in 3 cases, and in the retroperitoneal space in the remaining case (case 2). Conservative treatment including no oral intake and intravenous administration of broad spectrum antibiotics was performed in each case. Two to three days after colonic perforation, slight fever, localized peritoneal sign, leukocytosis, and C-reactive protein were recognized in all cases. However, symptoms and physical signs were resolved within a few days of the onset, and oral intake was resumed 5-9 days after perforation and continued in 3 cases without complications. On the other hand, delayed bleeding was recognized 2 days after EMR in the remaining case (case 2), and required an endoscopic hemostatic procedure and a long-term treatment. Endoscopic repair using a clipping device is a useful therapeutic procedure in the conservative treatment for iatrogenic colorectal perforation.

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