Zumblick Malte, Stathopoulos Petros, Gress Thomas Mathias, Denzer Ulrike Walburga
Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg-Campus, Marburg, Germany.
Case Rep Gastroenterol. 2022 Jun 28;16(2):425-429. doi: 10.1159/000525402. eCollection 2022 May-Aug.
Serious iatrogenic bowel injuries during screening colonoscopy are rare events. If a perforation is detected during colonoscopy, endoscopic therapy can be attempted depending on the size and type as well as local endoscopic experience. We report the case of a 54-year-old female patient who was treated by endoscopic vacuum therapy (EVT) for a rectal perforation she had suffered during an outpatient screening colonoscopy. Two hours after the complication, an emergency endoscopy was performed. A perforation of the lower third of the rectum with a longitudinal diameter of 4 cm and a depth of 2.5 cm was detected. Due to the deep defect and the suspected increased risk of abscess formation after mechanical perforation closure with endoclips, we decided to perform EVT. The therapy was performed over a total period of 7 days. The patient was symptom free at all times. On the 2nd and 5th day, the endoscopic findings were re-evaluated and the inserted endosponges were changed. The sponge was adjusted to the wound conditions at each check and its length was gradually shortened. The endoscopic findings improved steadily. The EVT was completed after 7 days with the result of complete wound closure. The inflammatory parameters dropped continuously from day 1. On day 8, the patient could be discharged from inpatient treatment. No complications occurred in the post-inpatient course. This case is an example of successful EVT after iatrogenic rectal perforation. EVT should be considered for iatrogenic rectal perforation when signs of systemic inflammation are present and primary mechanical wound closure appears critical due to the depth of the defect and the presumed risk of abscess formation.
在筛查结肠镜检查过程中发生严重医源性肠损伤是罕见事件。如果在结肠镜检查期间检测到穿孔，可根据穿孔的大小、类型以及当地的内镜经验尝试进行内镜治疗。我们报告一例54岁女性患者，她在门诊筛查结肠镜检查期间发生直肠穿孔，接受了内镜真空治疗（EVT）。并发症发生两小时后，进行了急诊内镜检查。发现直肠下三分之一处有一穿孔，纵向直径为4厘米，深度为2.5厘米。由于缺损较深，且怀疑使用内镜夹进行机械性穿孔闭合后脓肿形成风险增加，我们决定进行EVT。治疗共持续7天。患者在整个过程中均无症状。在第2天和第5天，重新评估内镜检查结果并更换插入的内镜海绵。每次检查时根据伤口情况调整海绵，其长度逐渐缩短。内镜检查结果稳步改善。7天后EVT完成，伤口完全闭合。炎症指标从第1天起持续下降。第8天，患者可出院。住院后过程中未发生并发症。该病例是医源性直肠穿孔后成功进行EVT的一个例子。当存在全身炎症迹象且由于缺损深度和假定的脓肿形成风险，初次机械性伤口闭合似乎很关键时，医源性直肠穿孔应考虑采用EVT。
