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 del...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.展开更多
基金Supported by Chonnam National University Hospital Biomedical Research Institute,No.BCRI19258.
文摘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.
