Endoscopic repair of delayed stomach perforation caused by penetrating trauma: A case report

Figure 1 Timeline of care. ER: Emergency room; CT: Computed tomography; UGI: Upper gastrointestinal; EGD: Esophagogastroduodenoscopy; POD: Postoperative day.

Figure 2 Initial computed tomography scan of the abdominal cavity. A-C: This scan shows left hemidiaphragmatic injury with herniation (A, orange circle), left hemopneumothorax (B, orange line), and perisplenic hemorrhage without signs of gastric perforation (C, green circle).

Figure 3 Follow-up computed tomography scan on 3^rd postoperative day. A and B: Free perforation of the upper stomach (A, orange arrowhead) with a hemoperitoneum and pneumoperitoneum (B) is noted.

Figure 4 Radiologic findings of re-perforated gastric wall. A and B: Computed tomography findings showing gastric wall re-perforation (A, orange arrowhead) and upper gastrointestinal series showing leakage of the gastric contents (B, orange line).

Figure 5 Primary closure of the perforated gastric wall with an endoscopic procedure. A and B: Endoscopic findings of the re-perforated gastric lumen (A) and its primary closure with endoloops and clips using the modified purse-string technique (B); C: Final endoscopic findings on 25^th postoperative day showing well-healed gastric wall.

Figure 6 Schematic diagram of the purse-string technique with pillar clips. A: After detection of the perforated stomach lumen and swollen edematous mucosa, pillar clips are fixed near the margin of the perforated wall; B and C: The endoloop is then placed at the outer margin of the pillar clips and is fixed with additional clips; D: Finally, the endoloop is fastened with the purse-string technique.