Hamada Koichi, Shiwa Yoshiki, Kurita Akira, Todate Yukitoshi, Horikawa Yoshinori, Techigawara Kae, Ishikawa Masafumi, Nagahashi Takayuki, Takeda Yuki, Fukushima Daizo, Nishino Noriyuki, Sakuma Hideo, Honda Michitaka
Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan.
Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.
Case Rep Gastroenterol. 2023 Mar 3;17(1):148-154. doi: 10.1159/000529480. eCollection 2023 Jan-Dec.
We report a case of a 70-year-old male with delayed perforation in the cecum treated by endoscopic ultrasonography-guided drainage for a pelvic abscess. The lesion was a 50-mm laterally spreading tumor, and endoscopic submucosal dissection (ESD) was performed. No perforation was detected during the operation, and en bloc resection was achieved. He had fever and abdominal pain on postoperative day (POD) 2. Computed tomography (CT) revealed the intra-abdominal free air, leading to a diagnosis of delayed perforation after ESD. Vital signs were stable, the perforation was considered minor, and endoscopic closure was attempted. The colonoscopy under fluoroscopy showed no perforation in the ulcer and no leakage of the contrast medium. He was managed conservatively with antibiotics and nothing per os. Symptoms improved; however, a follow-up CT on POD 13 revealed a 65-mm pelvic abscess, and endoscopic ultrasound (EUS)-guided drainage was successfully performed. The follow-up CT on POD 23 showed the reduction of abscess, and the drainage tubes were removed. Emergent surgical treatment is crucial in delayed perforation because it has a poor prognosis, and reports of conservative therapy for colonic ESD with delayed perforation are few. The present case was managed with antibiotics and EUS-guided drainage. Thus, EUS-guided drainage can be a treatment option for delayed perforation after colorectal ESD, if the abscess is localized.
我们报告一例70岁男性，其盲肠延迟穿孔，通过内镜超声引导下盆腔脓肿引流进行治疗。病变为一个50毫米的侧向扩散肿瘤，遂行内镜黏膜下剥离术（ESD）。手术过程中未检测到穿孔，实现了整块切除。术后第2天（POD 2）他出现发热和腹痛。计算机断层扫描（CT）显示腹腔内有游离气体，导致诊断为ESD术后延迟穿孔。生命体征稳定，穿孔被认为较小，尝试进行内镜闭合。透视下结肠镜检查显示溃疡处无穿孔，造影剂无渗漏。给予抗生素并禁食，对其进行保守治疗。症状有所改善；然而，POD 13的随访CT显示有一个65毫米的盆腔脓肿，遂成功进行了内镜超声（EUS）引导下引流。POD 23的随访CT显示脓肿缩小，引流管被拔除。对于延迟穿孔，紧急手术治疗至关重要，因为其预后较差，而关于结肠ESD延迟穿孔保守治疗的报道很少。本病例采用抗生素和EUS引导下引流进行治疗。因此，如果脓肿局限，EUS引导下引流可作为结直肠ESD术后延迟穿孔的一种治疗选择。
