Iida Toshifumi, Minato Yohei, Banjoya Susumu, Kimura Tomoya, Furuta Koichi, Nagae Shinya, Ito Yohei, Yamazaki Hiroshi, Takeuchi Nao, Takayanagi Shunya, Kano Yuki, Sakuno Takashi, Ono Kohei, Ohata Ken
Department of Gastrointestinal Endoscopy NTT Medical Center Tokyo Tokyo Japan.
DEN Open. 2023 Oct 20;4(1):e302. doi: 10.1002/deo2.302. eCollection 2024 Apr.
We present the case of a 45-year-old man who underwent a screening total colonoscopy and developed delayed perforation after a cold snare polypectomy in the descending colon and sigmoid colon. The patient developed abdominal pain and was referred to our department for further evaluation and treatment. On clinical examination, we noted lower abdominal tenderness, mild rebound pain, and elevated levels of inflammatory markers. Abdominal contrast-enhanced computed tomography confirmed the presence of free air in the abdomen. Since there were no signs of peritoneal inflammation and the vital signs were stable, we planned to perform endoscopic clip closure of the perforated area. The patient's symptoms improved with conservative management thereafter, including fasting, fluid replacement, and antibiotic administration. The patient was discharged on the 6th hospital day. In this case report, we discuss the usefulness of endoscopic clip closure in managing delayed perforation.
我们报告了一例45岁男性患者的病例，该患者接受了全结肠镜筛查，并在降结肠和乙状结肠进行冷圈套息肉切除术后发生延迟穿孔。患者出现腹痛，被转诊至我院进行进一步评估和治疗。临床检查时，我们发现下腹部压痛、轻度反跳痛以及炎症标志物水平升高。腹部增强CT证实腹腔内存在游离气体。由于没有腹膜炎体征且生命体征稳定，我们计划对穿孔部位进行内镜夹闭术。此后，通过禁食、补液和使用抗生素等保守治疗，患者症状有所改善。患者于住院第6天出院。在本病例报告中，我们讨论了内镜夹闭术在处理延迟穿孔方面的有效性。
