Successful endoscopic closure with endoscopic clips for endoscopic ultrasound related large duodenal perforation

Koji Takahashi; Ryo Saito; Yoshihisa Takeuchi; Chihiro Goto; Masami Awatsu; Kentaro Ishikawa; Hideaki Ishigami; Meiji Kuga; Yoshio Masuya

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Successful endoscopic closure with endoscopic clips for endoscopic ultrasound related large duodenal perforation

VernacularTitle:Successful endoscopic closure with endoscopic clips for endoscopic ultrasound related large duodenal perforation
Author: Koji TAKAHASHI ¹ ; Ryo SAITO ¹ ; Yoshihisa TAKEUCHI ¹ ; Chihiro GOTO ¹ ; Masami AWATSU ¹ ; Kentaro ISHIKAWA ¹ ; Hideaki ISHIGAMI ¹ ; Meiji KUGA ¹ ; Yoshio MASUYA ¹
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1. Department of Gastroenterology, Chiba Rosai Hospital, Japan
Keywords: endoscopic closure; endoscopic clips; endoscopic ultrasound; duodenal perforation
From:Journal of Rural Medicine 2021;16(3):165-169
CountryJapan
Language:English
Abstract: Objectives: Duodenal perforation as a complication of endoscopic ultrasound-guided fine needle aspiration may progress to acute peritonitis and septic shock. Open surgery, the standard treatment, can be avoided by performing closure during endoscopy using endoscopic clips.Patient: A 77-year-old woman was referred to our hospital with salivary gland swelling. She had elevated hepatobiliary enzymes and jaundice. Computed tomography (CT) revealed pancreatic head swelling and bile duct dilation. Endoscopic ultrasonography revealed a hypoechoic mass in the pancreatic head. The pancreatic head mass was punctured twice using a 22-gauge Franchine-type puncture needle at the duodenal bulb. The endoscope was advanced to the descending part of the duodenum, and part of the superior duodenal angle was perforated (diameter approximately 15 mm) with the endoscope. The duodenal mucosa around the perforation was immediately closed using endoscopic clips.Results: Abdominal CT showed gas in the peritoneal and retroperitoneal spaces. The patient experienced abdominal pain and fever and was treated with fasting and antibiotics. The gas gradually decreased, symptoms improved, and she was discharged 18 days after the perforation. Histopathologically, the pancreatic tissue was consistent as autoimmune pancreatitis.Conclusion: Endoscopic closure using endoscopic clips may be a better therapeutic option for duodenal perforation caused by endoscopy.