Yoon Jae Hyun, Jun Chung Hwan, Han Jae Pil, Yeom Ji-Woong, Kang Seung-Ku, Kook Hyun Yi, Choi Sung Kyu
Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea.
Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea.
World J Clin Cases. 2021 Feb 16;9(5):1228-1236. doi: 10.12998/wjcc.v9.i5.1228.
Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.
A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.
Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.
在内镜手术过程中，对穿孔胃壁进行一期内镜闭合大多有效且耐受性良好；然而，关于内镜治疗延迟性创伤性胃穿孔疗效的研究非常少。在此，我们报告一例采用另一种内镜方式成功治疗延迟性创伤性胃穿孔患者的新病例。
一名39岁女性因背部和左腹腔多处穿透伤就诊。初始影像学检查显示左侧膈肌破裂和脾周出血，无胃穿孔。急诊行膈肌破裂一期修复术，大网膜复位并缝合撕裂的肺；然而，3天后的计算机断层扫描显示胃壁出现延迟性游离穿孔。在急诊行胃壁一期修复的腹部手术后，术后15天发现再次穿孔。再次手术的高风险促使采用一种新的改良荷包缝合技术，使用2个内镜圈套器和11个内镜夹进行内镜干预。游离穿孔的胃壁成功修复，无需额外手术或干预。患者46天后出院，无任何并发症。
对于延迟性创伤性胃穿孔，内镜圈套器和夹子闭合术可作为再次手术的一种有用的治疗替代方法。
