Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2016; 4(8): 238-242
Published online Aug 16, 2016. doi: 10.12998/wjcc.v4.i8.238
Successful endoscopic closure of a colonic perforation one day after endoscopic mucosal resection of a lesion in the transverse colon
Kazuya Inoki, Taku Sakamoto, Masau Sekiguchi, Masayoshi Yamada, Takeshi Nakajima, Takahisa Matsuda, Yutaka Saito
Kazuya Inoki, Taku Sakamoto, Masau Sekiguchi, Masayoshi Yamada, Takeshi Nakajima, Takahisa Matsuda, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Masau Sekiguchi, Takahisa Matsuda, Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Inoki K, Sakamoto T and Saito Y designed the report, collected the patient’s clinical information and wrote the paper; Sekiguchi M, Yamada M, Nakajima T and Matsuda T revised the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at National Cancer Center Hospital, Tokyo, Japan.
Informed consent statement: The patient involved in this study gave his informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Taku Sakamoto, MD, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Telephone: +81-3-35422511 Fax: +81-3-35423815
Received: March 1, 2016
Peer-review started: March 2, 2016
First decision: April 15, 2016
Revised: May 4, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: August 16, 2016

A 73-year-old man underwent endoscopic mucosal resection (EMR) of a 20-mm flat elevated lesion on the transverse colon. The morning after the procedure, he started to have severe right upper quadrant pain after his first meal. A computed tomography scan revealed free air and a stomach filled with food. He was diagnosed to have delayed post-EMR intestinal perforation. He underwent emergent colonoscopy and clipping of the perforated site. He was discharged 8 d after the endoscopic closure without the need for surgical intervention. The meal was not the cause of the colon transversum perforation.

Keywords: Colonoscopy, Colorectal tumors, Endoscopic surgical procedure, Emergencies, Intestinal perforation

Core tip: The prompt and adequate management of post-operative gastrointestinal perforation is imperative. For delayed perforations, surgical management is the most common option. Herein we report a case of delayed colonic perforation that was successfully repaired by an endoscopic approach, even after the patient ingested food. We describe the techniques and highlight the importance of adequate bowel preparation for a favorable outcome.