Homma Satoru, Tokodai Kazuaki, Watanabe Minami, Takaya Kai, Hashizume Eiji
Department of Surgery, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata, 998-8501, Japan.
Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
Clin J Gastroenterol. 2017 Apr;10(2):124-127. doi: 10.1007/s12328-016-0709-9. Epub 2016 Dec 21.
Delayed perforation occurs after 0.5% of endoscopic submucosal dissection (ESD) procedures for early gastric cancer (EGC). This complication can occur within a few hours or days after ESD. There are few reports in the English literature concerning patients who developed delayed perforation after ESD for EGC. An 81-year-old woman was referred to the emergency department of our hospital on the 24th day after ESD because of abdominal pain. We diagnosed her with delayed perforation with peritonitis after ESD for EGC using computed tomography (CT) and esophagogastroduodenoscopy (EGD). We performed primary closure with interrupted sutures covered via pedicled omentoplasty. The patient was discharged 13 days after surgery without any postoperative complications. Delayed perforation is generally treated with conservative, surgical, or endoscopic methods. Several benefits of endoscopic clipping have been reported. However, in the present case, we performed emergency surgery while considering possible fatal complications, such as severe peritonitis. It is important to recognize delayed perforation in the differential diagnosis. The decision to perform surgery should be made after carefully considering the degree of perforation based on EGD, CT findings, and patient conditions.
早期胃癌（EGC）内镜黏膜下剥离术（ESD）术后延迟穿孔发生率为0.5%。这种并发症可在ESD术后数小时或数天内发生。英文文献中关于EGC行ESD术后发生延迟穿孔患者的报道较少。一名81岁女性在ESD术后第24天因腹痛被转诊至我院急诊科。我们通过计算机断层扫描（CT）和食管胃十二指肠镜检查（EGD）诊断她为EGC行ESD术后延迟穿孔伴腹膜炎。我们采用带蒂大网膜成形术覆盖的间断缝合进行一期缝合。患者术后13天出院，无任何术后并发症。延迟穿孔一般采用保守、手术或内镜方法治疗。内镜夹闭术的一些益处已有报道。然而，在本病例中，我们在考虑可能的致命并发症（如严重腹膜炎）的情况下进行了急诊手术。在鉴别诊断中认识到延迟穿孔很重要。应根据EGD、CT检查结果及患者情况，仔细考虑穿孔程度后再决定是否进行手术。
