Delayed perforation occurring on the 24th day after endoscopic submucosal dissection for early gastric cancer

Delayed perforation occurs after 0.5% of endoscopic submucosal dissection (ESD) procedures for early gastric cancer (EGC). This complication can occur within a few hours or days after ESD. There are few reports in the English literature concerning patients who developed delayed perforation after ESD...

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Bibliographic Details
Published in:Clinical journal of gastroenterology 2017-04, Vol.10 (2), p.124-127
Main Authors: Homma, Satoru, Tokodai, Kazuaki, Watanabe, Minami, Takaya, Kai, Hashizume, Eiji
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adenocarcinoma - surgery
Aged, 80 and over
Case Report
Colorectal Surgery
Endoscopic Mucosal Resection - adverse effects
Endoscopic Mucosal Resection - methods
Endoscopy, Digestive System
Female
Gastroenterology
Gastroscopy - adverse effects
Gastroscopy - methods
Hepatology
Humans
Medicine
Medicine & Public Health
Peritonitis - diagnosis
Peritonitis - etiology
Stomach Neoplasms - surgery
Stomach Ulcer - diagnosis
Stomach Ulcer - etiology
Surgical Oncology
Tomography, X-Ray Computed
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Summary:Delayed perforation occurs after 0.5% of endoscopic submucosal dissection (ESD) procedures for early gastric cancer (EGC). This complication can occur within a few hours or days after ESD. There are few reports in the English literature concerning patients who developed delayed perforation after ESD for EGC. An 81-year-old woman was referred to the emergency department of our hospital on the 24th day after ESD because of abdominal pain. We diagnosed her with delayed perforation with peritonitis after ESD for EGC using computed tomography (CT) and esophagogastroduodenoscopy (EGD). We performed primary closure with interrupted sutures covered via pedicled omentoplasty. The patient was discharged 13 days after surgery without any postoperative complications. Delayed perforation is generally treated with conservative, surgical, or endoscopic methods. Several benefits of endoscopic clipping have been reported. However, in the present case, we performed emergency surgery while considering possible fatal complications, such as severe peritonitis. It is important to recognize delayed perforation in the differential diagnosis. The decision to perform surgery should be made after carefully considering the degree of perforation based on EGD, CT findings, and patient conditions.
ISSN:1865-7257
1865-7265
DOI:10.1007/s12328-016-0709-9