Unanticipated adverse event of endoscopic submucosal dissection: Rectal perforation associated with injury of the cecum wall, Report of a case

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  • To Kazuo
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Takeshita Hiroaki
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Wakata Kouki
    Department of Surgery, National Hospital Organization Ureshino Medical Center
  • Tominaga Tetsuro
    Department of Surgery, National Hospital Organization Ureshino Medical Center
  • Kunizaki Masaki
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Abo Takafumi
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Hidaka Shigekazu
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Nanashima Atsushi
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Sawai Terumitsu
    Division of Nursing, Nagasaki University, School of Health Science, Faculty of Medicine
  • Nagayasu Takeshi
    Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • Oka Tadayuki
    Department of Surgery, National Hospital Organization Ureshino Medical Center

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Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer, but it is not generally used for colorectal lesions because of its high risk of adverse events. An unanticipated adverse event of rectal ESD is reported. A 71-year-old man was found to have a laterally spreading tumor at the upper rectum. ESD was performed. During the ESD, rectal perforation occurred, and emergency laparoscopic surgery was performed. At the operation, rectal perforation with retroperitoneal emphysema was detected. Surprisingly, an 8-cm-long, lacerated wound was found at the cecum wall. It was thought to have been caused by heat injury due to ESD. The perforated site was resected, and the laceration of the cecum was repaired by extracorporeal suture. In patients with perforation during ESD, it is essential to keep in mind that other organs might have heat-induced injury, and the patient should be more carefully followed.

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