Ye Liansong, Wang Yiping, Hou Wenxiu, Wu Chuncheng, Yuan Xianglei, Khan Naveed, Hu Bing
Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan.
Department of Gastroenterology, Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, Zhejiang.
Medicine (Baltimore). 2019 May;98(22):e15883. doi: 10.1097/MD.0000000000015883.
Delayed perforation of duodenal endoscopic submucosal dissection (ESD) was reported to be up to 14.3%. High invasive surgery remains the main treatment for delayed duodenal perforation.
A 56-year-old woman presented with abdominal pain and fever at 1st day after ESD for treating a large laterally spreading tumor in the second part of duodenum.
Emergent abdominal computed tomography revealed the presence of duodenal perforation.
Endoscopic purse-string technique was used to partially close the large mucosal defect. Percutaneous endoscopic gastrostomy was conducted for gastric drainage and proximal drainage of the wound. A nasointestinal decompression tube was placed for distal drainage of the wound.
No further symptoms were noted after 5 days. Both upper gastrointestinal series and endoscopy confirmed the healing of the wound.
Partial closure of the mucosal defect followed by adequate drainage can be selected as a preferred choice for management of delayed duodenal perforation. It may also serve as an alternative for prevention of delayed perforation when complete closure of the mucosal defect is technically difficult or impossible.
据报道，十二指肠内镜黏膜下剥离术（ESD）延迟穿孔发生率高达14.3%。高侵袭性手术仍然是延迟性十二指肠穿孔的主要治疗方法。
一名56岁女性在十二指肠第二部ESD治疗巨大侧向发育肿瘤后第1天出现腹痛和发热。
急诊腹部计算机断层扫描显示存在十二指肠穿孔。
采用内镜荷包缝合技术部分封闭大的黏膜缺损。行经皮内镜下胃造瘘术进行胃引流及伤口近端引流。放置鼻肠减压管进行伤口远端引流。
5天后未再出现症状。上消化道造影和内镜检查均证实伤口愈合。
黏膜缺损部分封闭并充分引流可作为延迟性十二指肠穿孔治疗的首选方法。当黏膜缺损完全封闭在技术上困难或不可能时，它也可作为预防延迟穿孔的替代方法。
