Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3608
Peer-review started: April 8, 2020
First decision: April 28, 2020
Revised: April 29, 2020
Accepted: July 14, 2020
Article in press: July 14, 2020
Published online: August 26, 2020
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely used for the treatment of early gastrointestinal cancer. Endoscopic piecemeal mucosal resection (EPMR) is derived from the combination of EMR and ESD. Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication, sometimes requiring surgery. There are some associated risk factors, including patient- (location, diameter, and presence of fibrosis) and procedure-related factors. Early recognition and timely treatment are crucial for its management.
We report a case in which delayed perforation with peritonitis was treated using endoscopic closure. A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature. Fifteen hours after endoscopic resection, peritonitis caused by delayed perforation occurred and gradually aggravated. Conservative treatment was ineffective and no obvious perforation was observed. After timely endoscopic closure, the patient was discharged on postoperative day 4.
In occasion of localized peritonitis aggravating without macroscopic perforation, endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.
Core tip: We report a case in which delayed perforation occurred 15 h after colonic endoscopic resection of a laterally spreading tumor in the colonic hepatic curvature. Peritonitis aggravated progressively without macroscopic perforation and conservative treatment had no effect. Micro-perforation was successfully closed under endoscopy with clips to avoid worse complications and surgical intervention.