Zhou Ge-Yu-Jia, Hu Jin-Long, Wang Sheng, Ge Nan, Liu Xiang, Wang Guo-Xin, Sun Si-Yu, Guo Jin-Tao
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
World J Clin Cases. 2020 Aug 26;8(16):3608-3615. doi: 10.12998/wjcc.v8.i16.3608.
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely used for the treatment of early gastrointestinal cancer. Endoscopic piecemeal mucosal resection (EPMR) is derived from the combination of EMR and ESD. Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication, sometimes requiring surgery. There are some associated risk factors, including patient- (location, diameter, and presence of fibrosis) and procedure-related factors. Early recognition and timely treatment are crucial for its management.
We report a case in which delayed perforation with peritonitis was treated using endoscopic closure. A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature. Fifteen hours after endoscopic resection, peritonitis caused by delayed perforation occurred and gradually aggravated. Conservative treatment was ineffective and no obvious perforation was observed. After timely endoscopic closure, the patient was discharged on postoperative day 4.
In occasion of localized peritonitis aggravating without macroscopic perforation, endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.
内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）已广泛应用于早期胃肠道癌的治疗。内镜分片黏膜切除术（EPMR）是EMR和ESD的联合术式。结肠EPMR术后迟发性穿孔伴腹膜炎是一种罕见但严重的并发症，有时需要手术治疗。存在一些相关危险因素，包括患者因素（部位、直径和纤维化情况）及手术相关因素。早期识别和及时治疗对其处理至关重要。
我们报告1例采用内镜闭合术治疗迟发性穿孔伴腹膜炎的病例。一名54岁男性被诊断为结肠肝曲处直径30 mm的侧向扩散肿瘤。内镜切除术后15小时，发生迟发性穿孔导致的腹膜炎并逐渐加重。保守治疗无效且未观察到明显穿孔。及时行内镜闭合术后，患者于术后第4天出院。
在局部腹膜炎加重但无肉眼可见穿孔的情况下，内镜闭合术是早期生命体征稳定的迟发性穿孔的有效治疗方法。
