Endoscopic Management of an Iatrogenic Colonic Perforation Using Standard Hemoclips

Abstract

Iatrogenic colonic perforation is an unusual but life‑threatening complication of colonoscopy. The recent advancement in endoscopy technology has made nonoperative treatment a safe and effective option for managing such perforations. A 70‑year‑old man sustained an iatrogenic sigmoid perforation during diagnostic colonoscopy. The abdominal X‑ray showed free gas under diaphragm. He was started on conservative management and intravenous antibiotics. He underwent a second colonoscopy after 2.5‑h, perforation was identified and closed with standard hemoclips. He recovered well and was discharged from hospital 6 days later. There are only a handful of reports in the medical literature describing successful outcomes following endoscopic management. Most of the cases have been managed with over‑the‑scope clips or endoscopic sutures that are quite expensive. In the present report, an iatrogenic sigmoid perforation was managed endoscopically with standard hemoclips. The hemoclip can be an effective, yet economical method of perforation repair in selected cases.

KEYWORDS

Endoscopic clipping - endoscopic repair - iatrogenic colonic perforation

• REFERENCES

• 1 Clements RH, Jordan LM, Webb WA. Critical decisions in the management of endoscopic perforations of the colon. Am Surg 2000; 66: 91-3
• 2 Repici A, Pellicano R, Strangio G, Danese S, Fagoonee S, Malesci A. et al. Endoscopic mucosal resection for early colorectal neoplasia: Pathologic basis, procedures, and outcomes. Dis Colon Rectum 2009; 52: 1502-15
• 3 Lohsiriwat V. Colonoscopic perforation: Incidence, risk factors, management and outcome. World J Gastroenterol 2010; 16: 425-30
• 4 Cai SL, Chen T, Yao LQ, Zhong YS. Management of iatrogenic colorectal perforation: From surgery to endoscopy. World J Gastrointest Endosc 2015; 7: 819-23
• 5 Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: A review of 30,366 patients. Surg Endosc 2007; 21: 994-7
• 6 Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: From diagnostic to therapeutic colonoscopy. Endoscopy 2009; 41: 941-51
• 7 Bleier JI, Moon V, Feingold D, Whelan RL, Arnell T, Sonoda T. et al. Initial repair of iatrogenic colon perforation using laparoscopic methods. Surg Endosc 2008; 22: 646-9
• 8 Yoshikane H, Hidano H, Sakakibara A, Ayakawa T, Mori S, Kawashima H. et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 1997; 46: 464-6
• 9 Cho SB, Lee WS, Joo YE, Kim HR, Park SW, Park CH. et al. Therapeutic options for iatrogenic colon perforation: Feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc 2012; 26: 473-9
• 10 de'Angelis N, Di Saverio S, Chiara O, Sartelli M, Martínez-Pérez A, Patrizi F. et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg 2018; 13: 5
• 11 Kantsevoy SV, Bitner M, Hajiyeva G, Mirovski PM, Cox ME, Swope T. et al. Endoscopic management of colonic perforations: Clips versus suturing closure (with videos). Gastrointest Endosc 2016; 84: 487-93