Merali N, Hussain A
Minimal Access Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, BR6 8ND London, UK.
Minimal access unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Honorary Senior Lecturer at King's College Medical School, Orpington, BR6 8ND London, UK.
Int J Surg Case Rep. 2015;9:31-3. doi: 10.1016/j.ijscr.2015.02.036. Epub 2015 Feb 20.
An iatrogenic caecal perforation is rare, but a serious complication associated with significant morbidity and mortality. We present a 4min and 50s video on a new improvisation undertaken during laparoscopic management of post-polypectomy caecal perforation.
Our patient presented with an acute abdomen following endoscopic polypectomy. At surgery, the site of caecal perforation was close to the appendicular base with devitalization tissue, secondary to diathermy usage. The hallmark of safety within this novel technique included fresh healthy tissue margins within the endoloop (detachable snare ligation) and ensuring no ischemic tissue was gathered. Complete freeing of the appendix and meso-appendicular base was required and securing three endoloops proximal to the site of perforation. The post-operative course was uneventful.
The World Society of Emergency Surgery (WSES) 2013 guidelines suggested an early laparoscopic approach is a safe and effective treatment for colonoscopy-related colonic perforation. There are no national guidelines and the management is dictated by the clinical condition of the patient, co-morbidity, size and site of perforation as well as the scale of bowel preparation, and surgical experience.
The endoloop technique described, undertaken during a laparoscopy is a novel approach. It is a simple and effective method, reminding clinicians to adapt techniques when necessary. Nevertheless, it is only limited to perforations around the appendicular base.
医源性盲肠穿孔罕见，但却是一种严重并发症，伴有显著的发病率和死亡率。我们展示一段时长4分50秒的视频，内容是关于腹腔镜处理息肉切除术后盲肠穿孔时采用的一种新的改良方法。
我们的患者在内镜下息肉切除术后出现急腹症。手术时，盲肠穿孔部位靠近阑尾根部，伴有因使用电刀导致的组织失活。这项新技术的安全标志包括在套扎环（可分离圈套器结扎）内有新鲜健康的组织边缘，并确保没有聚集缺血组织。需要完全游离阑尾及阑尾系膜根部，并在穿孔部位近端固定三个套扎环。术后过程顺利。
世界急诊外科学会（WSES）2013年指南建议，早期腹腔镜手术方法是治疗结肠镜检查相关结肠穿孔的一种安全有效的方法。目前尚无国家指南，治疗方法取决于患者的临床状况、合并症、穿孔的大小和部位、肠道准备情况以及手术经验。
本文所述的在腹腔镜手术中使用套扎环技术是一种新方法。它是一种简单有效的方法，提醒临床医生在必要时调整技术。然而，它仅适用于阑尾根部周围的穿孔。
