Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1228-1236
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1228
Endoscopic repair of delayed stomach perforation caused by penetrating trauma: A case report
Jae Hyun Yoon, Chung Hwan Jun, Jae Pil Han, Ji-Woong Yeom, Seung-Ku Kang, Hyun Yi Kook, Sung Kyu Choi
Jae Hyun Yoon, Sung Kyu Choi, Department of Gastroenterology and Hepatology, Chonnam National University Hospital and College of Medicine, Gwangju 61469, South Korea
Chung Hwan Jun, Jae Pil Han, Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo 58643, South Korea
Ji-Woong Yeom, Department of Surgery, Mokpo Hankook Hospital, Mokpo 58643, South Korea
Seung-Ku Kang, Department of Cardiothoracic Surgery, Mokpo Hankook Hospital, Mokpo 58643, South Korea
Hyun Yi Kook, Department of Nursing, Chonnam National University Hospital, and College of Nursing, Gwangju 61469, South Korea
Author contributions: Jun CH contributed conceptualization; Han JP, Yeom JW, Kang SK and Kook HY contributed methodology; Jun CH and Choi SK contributed supervision; Yoon JH and Jun CH wrote original draft; Yoon JH, Jun CH and Choi SK reviewed and edited the manuscript.
Supported by Chonnam National University Hospital Biomedical Research Institute, No. BCRI19258.
Informed consent statement: The patient provided written informed consent for the publication of this case report (in accordance with the Declaration of Helsinki).
Conflict-of-interest statement: The authors of this work have nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chung Hwan Jun, MD, Chief Doctor, Department of Internal Medicine, Mokpo Hankook Hospital, Mokpo Yeongsanro 483, Mokpo 58643, South Korea. estevanj@naver.com
Received: November 26, 2020
Peer-review started: November 26, 2020
First decision: December 8, 2020
Revised: December 13, 2020
Accepted: December 29, 2020
Article in press: December 29, 2020
Published online: February 16, 2021
Processing time: 64 Days and 21.5 Hours
Abstract
BACKGROUND

Primary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.

CASE SUMMARY

A 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.

CONCLUSION

Endoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.

Keywords: Surgical endoscopy; Trauma; Stomach; Re-perforation; Endoloop; Case report

Core Tip: Primary closure of a perforated gastric wall caused by penetrating trauma has mostly been treated with surgery, and the role of endoscopy is not well established. This case report describes the successful closure of a free perforated gastric wall using a modified purse-string technique involving endoloops and endoscopic clips. This technique successfully managed delayed re-perforation of the stomach without complications or subsequent surgery. The modified purse-string technique can be a useful therapeutic alternative to re-surgery for delayed gastric perforation, contributing to lower invasiveness and faster recovery.