Department of Internal Medicine, Osaka Koseinenkin Hospital, Fukushima 4-2-78, Fukushima-ku, Osaka, Osaka, Japan.
Gastric Cancer. 2012 Jan;15(1):111-4. doi: 10.1007/s10120-011-0089-2. Epub 2011 Sep 23.
Delayed perforation occurring after endoscopic submucosal dissection (ESD) is a rare but serious complication which sometimes requires emergent surgery. However, reports of its characteristics, including endoscopic imaging and management, are not fully detailed. A 70-year-old woman was referred to our hospital for the treatment of early gastric cancer. On the day of the ESD, hematemesis was observed because of a Mallory-Weiss tear, and a visible vessel in the post-ESD ulcer was additionally treated endoscopically by coagulation. Second-look endoscopic examination on the next day revealed a perforation 3 mm in diameter at the treated vessel in the ulcer. The shape of the perforation was round and the color of the surrounding muscle layer had become whitish. The perforation was closed with endoclips, and decompression of the pneumoperitoneum was performed. The patient was conservatively managed and was discharged 13 days after the ESD. We show endoscopic images of delayed perforation and discuss the mechanism and management of this complication.
内镜黏膜下剥离术（ESD）后发生的延迟性穿孔是一种罕见但严重的并发症，有时需要紧急手术。然而，关于其特征的报告，包括内镜成像和处理，并不完全详细。一名 70 岁女性因 Mallory-Weiss 撕裂而呕血，被转至我院接受早期胃癌治疗。在 ESD 当天，由于 ESD 后溃疡处可见血管，因此另外进行了内镜下止血。次日的内镜复查显示，在溃疡处处理过的血管上有一个 3 毫米直径的穿孔。穿孔的形状为圆形，周围肌肉层的颜色已变白。使用内镜夹闭合穿孔，并进行气腹减压。患者接受保守治疗，在 ESD 后 13 天出院。我们展示了延迟性穿孔的内镜图像，并讨论了这种并发症的发生机制和处理方法。
