Clinical Endoscopy

Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model: Joung-Ho Han, Myounghwan Kim, Tae Hoon Lee, Hyun Kim, Yunho Jung, Seon Mee Park, Heebok Chae, Seijin Youn, Ji Yun Shin, In-Kwang Lee, Tae Soo Lee, Seok Hwa Choi; Clin Endosc 2015;48(6):534-541. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.534

Background
/Aims: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model.
Methods
We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination.
Results
The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis.
Conclusions
EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

Citations

Citations to this article as recorded by

Endoscopic Management of Iatrogenic Colon Perforation
Yunho Jung
Clinical Endoscopy.2020; 53(1): 29. CrossRef
Endoluminal closure of an unrecognized penetrating stab wound of the duodenum with endoscopic band ligation: A case report
Dae Hoon Kim, Hanlim Choi, Ki Bae Kim, Hyo Yung Yun, Joung-Ho Han
World Journal of Clinical Cases.2019; 7(20): 3271. CrossRef
Endoscopic management of iatrogenic gastrointestinal perforations
Kan Wang, Jihao Shi, Linna Ye
Laparoscopic, Endoscopic and Robotic Surgery.2019; 2(2): 41. CrossRef
Endoscopic Band Ligation Is Able to Close Perforations Caused by Colonoscopy: A Porcine Model Study
Yidong Yang, Xianyi Lin, Siwei Tan, Xiaoli Huang, Zijun Xie, Xuan Xu, Yiming Lei, Bin Wu
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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A Case of a Colon Perforation Due to a Soft Rectal Foreign Body: Jeong Hwa Lee, M.D., Sang Bum Kang, M.D., Dong Cheon Ha, M.D., Ki Huyn Kwon, M.D., Seung Woo Lee, M.D., Yeon Soo Kim, M.D., Dong Soo Lee, M.D. and Soon Woo Nam, M.D.; Korean J Gastrointest Endosc 2011;43(1):52-55. Published online July 28, 2011

Abstract PDF: Numerous foreign bodies in the rectum have been reported in the literature. Their removal can be challenging depending on the size and shape of the objects and their anatomical location in the rectum. A 64-year-old man presented to the emergency department after inserting a sausage into his rectum. He had some rectal discomfort and lower abdominal pain. There were no signs of bowel perforation. We attempted to extract the sausage impacted in the recto-sigmoid junction by colonoscopy using a snare and grasping forceps but failed to extract the foreign body. Unfortunately, a colon perforation had occurred, and the sausage was eventually extracted by performing a colostomy at the recto-sigmoid junction with primary repair. We report this case of a soft rectal foreign body impacted in the recto-sigmoid colon complicated by a colon perforation with a literature review. (Korean J Gastrointest Endosc 2011;43:52-55)

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Colonoscopic Perforation During a Diagnostic Colonoscopy: Jeong Ho Kim, M.D., Eun Jung Jeon, M.D., Jun Ho Song, M.D., Sang Hun Lee, M.D., Jin Hwan Jung, M.D., Dae Young Cheung, M.D., Jin Il Kim, M.D., Soo Heon Park, M.D. and Jae Kwang Kim, M.D.; Korean J Gastrointest Endosc 2011;42(5):289-292. Published online May 28, 2011

Abstract PDF

Background/Aims: Colonoscopy is a useful method for detecting colorectal disease, but complications are on the rise due to the increasing number of colonoscopies. The aim of this study was to analyze colon perforations following diagnostic colonoscopies.

Methods: We performed retrospective reviews of all patients with colonoscopic perforations between January 2000 and June 2010.

Results: Of 25,883 diagnostic colonoscopies performed, seven cases of colon perforations were reported. Among those, five cases had an abdominal operation history; the site of perforation was the sigmoid colon in three cases and the rectum in four cases. The manipulation type was forward viewing in three cases and retroflexion in four cases. The time to diagnosis was immediate in six cases and delayed in one case, and treatment was conservative management in three cases and surgical management in four cases.

Conclusions: Special attention is required for patients with a previous abdominal operation and retroflexion. Even after perforations occur, favorable outcomes can be obtained by conservative treatment if the patient's condition is stable, the bowel preparation is proper, and there are no signs of peritonitis. (Korean J Gastrointest Endosc 2011;42:289-292)

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A Case of Transverse Colon Perforation after Colonoscopy in a Patient withEnterocolitis Caused by Non-typhoidal Group D Salmonella: Ki Hoon Kim, M.D., Suck Chei Choi, M.D., Tae Hyeon Kim, M.D., Geom Seog Seo, M.D., Chang Soo Choi, M.D., Sung O Seo, M.D., Mi Jin Song, M.D. and Ji Hyun Cho*, M.D.; Korean J Gastrointest Endosc 2008;36(6):395-400. Published online June 30, 2008

Abstract PDF: Clinical manifestations of Salmonella infection are variable such as enterocolitis, bacteremia, enteric fever, focal infection and asymptomatic carrier status. Among these presentations, enterocolitis is the most common clinical manifestation and can be diagnosed by the use of fecal specimens. Patients with severe infectious colitis are at increased risk of developing a colon perforation after colonoscopy due to colon trauma. We report a case of a 31-year-old woman with transverse colon perforation after colonoscopy that was diagnosed with enterocolitis caused by infection with non-typhoidal group D Salmonella. (Korean J Gastrointest Endosc 2008;36:395-400)

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Conservative Treatment of Colonoscopic Perforations: Yong Keun Cho, M.D., Sang Woo Nam, M.D.*, Hyun Chul Kim, M.D.*, Eun Young Ko, M.D., Yang Ho Kim, M.D., Seung Min Park, M.D., Yong Ung Lee, M.D. and Jin Woong Cho, M.D.; Korean J Gastrointest Endosc 2006;33(1):20-25. Published online July 30, 2006

Abstract PDF: Background
/Aims: Colonoscopic perforation can be treated by both operative or non-operative methods. Non-operative management, and especially conservative management, may be appropriate for selected individuals. We wanted to verify the usefulness of performing conservative management for treating colonoscopic perforations. Methods: We reviewed the medical records of the colonoscopic perforation cases that occurred in the recent 5 yrs. 11 cases of perforation occurred from among 8,536 colonoscopic procedures. Results: Ten cases occurred from a therapeutic procedure (five from polypectomy and another five occurred from an endoscopic (submucosal dissection) and one case occurred from a diagnostic procedure. The perforation sites were the ascending colon (three cases), transverse colon (two cases), descending colon (one case), sigmoid colon (two cases), and rectum (three cases). There were five intraperitoneal perforations and five retroperitoneal perforations. All the cases were detected within 12 hours and all the cases had received good bowel preparation. 10 cases were managed conservatively (nothing by mouth, broad spectrum antibiotics and, Levin tube suction). One case was managed by an operative procedure due to the large size of the defect and the patient's wish. All the patients recovered without complications. The mean hospital stay was 9.5 days. Conclusions: Colonoscopic perforation can managed conservatively in selected cases, such as for those cases that will undergo post-therapeutic colonoscopy and those cases that have undergone good bowel preparation. (Korean J Gastrointest Endosc 2006;33:20⁣25)

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A Case of Successful Endoscopic Therapy in Iatrogenic Perforation of the Colon during Colonoscopy: Jai Gyu Lee, M.D., Jin Woong Cho, M.D., Paul Kim, M.D., Ji Eun Lee, M.D., Jin Gyu Lee, Sung Min Lim, M.D., In Seok Seo, M.D., Yang Ho Kim, M.D. and Yong Ung Lee, M.D. M.D.,; Korean J Gastrointest Endosc 2004;29(4):213-216. Published online October 30, 2004

Abstract PDF: Colonoscopy is a safe and standard procedure for diagnosis and therapy of colonic disorders. Iatrogenic colonic perforation during diagnostic colonoscopy, a rare abdominal emergency, has an 0.3∼0.8% incidence rate. The choice of treatment for this complication remains controversial. Prompt operative intervention is preferred to minimize morbidity and mortality. However, operative intervention is invasive and needs a long-term recovery period. Conservative treatment is less invasive but can lead to more extensive surgery in case of treatment failure. Very important point on the treatment of iatrogenic perforation of the colon during diagnostic colonoscopy is to avoid the leaking of intestinal contents into the intraperitoneal cavity. We report here a case in which an iatrogenic perforation of the colon during diagnostic colonoscopy was successfully treated by endoscopic clip therapy. (Korean J Gastrointest Endosc 2004;29:213⁣216)

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내시경적 대장용종절제 후 지연발견된 천공을 내시경적 치료로 호전된 1 예 ( A Case of Successful Endoscopic Therapy in Delayed Diagnosed Perforation after Endoscopic Colon Polypectomy ): Korean J Gastrointest Endosc 2001;23(4):240-244. Published online November 30, 2000

Abstract PDF: With the wide use of colonoscopy and develoment of technology, colon tumors and colon polyps are being found frequently and for the treatment of colon polyp, endoscopic polypectomy is used at present. The most common complications of endoscopic colon polypectomy are hemorrhage and perforation. Colon perforation is an abdominal emergency with high mortality. When colon perforation happens, surgical resection was being used at past. But when colon perforations are resulted from therapeutic colonoscopy, devoid of down stream obstacles with a perfectly prepared colon, and the patient's general condition is satisfactory, colon porforation is successfully treated by conservative measures. But, in delayed diagnosed perforation endoscopic treatment is controversial yet. We report here a case which sustained iatrogenic delayed diagnosed perforation of the sigmoid colon caused by polypectomy that was successfully treated by endoscopic clip therapy. (Korean J Gastrointest Endosc 2001;23:240-244)

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