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 FOUR CASES OF IATROGENIC COLORECTAL PERFORATION SUCCESSFULLY TREATED BY CONSERVATIVE THERAPY WITH ENDOSCOPIC REPAIR USING A CLIPPING DEVICE
医原性大腸穿孔に対して止血用クリップによる内視鏡的穿孔部閉鎖術を行い,保存的治療にて治癒し得た4例を経験した.穿孔の原因は,2例が内視鏡的粘膜切除術(endos-copic mucosal resection;EMR),1例が内視鏡的粘膜下切開剥離術(endoscopic sub-mucosal dissection; ESD),1例がスコープ挿入時であった.いずれの症例も直ちに止血用クリップを用いて穿孔部を閉鎖し,絶飲食,補液,抗生剤投与により保存的に治療を行った.出血を伴った1例では3週間程度の加療期間を要したが,他の3症例では1週間程度の保存的治療で治癒し得た.
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.
- 日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy
日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy 48(4), 1006-1013, 2006-04-20