Subscribe to RSS
DOI: 10.1055/s-0030-1256002
© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic closure of a perforated peptic ulcer
Fredrik Swahn MD
Division of Surgery
Department of Clinical Science,
Intervention and Technology (CLINTEC)
Karolinska University
Hospital
Huddinge
SE-141 86 Stockholm
Sweden
Fax: +46-08-58586366
Email: fredrik.swahn@karolinska.se
Publication History
Publication Date:
26 January 2011 (online)
A 42-year old woman with Wilson’s disease was admitted with a history of acute-onset upper abdominal pain. Physical examination revealed signs of peritonitis in the upper abdomen, and an abdominal CT scan demonstrated a localized pneumoperitoneum ([Fig. 1]).
An esophagogastroduodenoscopy (EGD) (GIF2T60 double-channel endoscope; Olympus, Tokyo, Japan) was performed under general anesthesia using CO2 insufflation, and revealed a clearly demarcated (2 × 3 mm) perforated prepyloric ulcer in the anterior wall ([Fig. 2]).
The patient’s clinical condition permitted an attempt at endoscopic management. To achieve closure, the edges of the ulcer were approximated with a twin grasper (OTSC Twin Grasper; Ovesco Endoscopy AG, Tübingen, Germany) whereupon an over-the-scope clip (OTSC) (Ovesco) was applied ([Figs. 3] and [4]).
The procedure was supplemented with intra-abdominal lavage using 2 liters of lukewarm saline instilled through an infraumbilical drain (Blake Silicone Drain; 7 mm) and subsequently evacuated. So that it was possible to document the efficacy of the procedure, the patient was given oral methylene blue to drink on the first postoperative day. Since no blue fluid showed up in the drainage, the intra-abdominal drain was removed. On the third postoperative day, oral feeds were started. A follow-up EGD on day 4 demonstrated an intact OTSC closure ([Fig. 5]) and the patient was discharged from the hospital the same day with treatment for Helicobacter pylori eradication.
Biopsies from the ulcer margin showed benign histomorphology. At the follow-up visit 4 weeks later, the patient reported a completely uneventful recovery with immediate return to work, and an EGD revealed complete mucosal healing with the OTSC still in place.
In summary, this report contains one of the original descriptions of the use of the OTSC system for closure of a perforated peptic ulcer. This technique will have implications for the endoscopic repair of transmural defects in the gastrointestinal tract.
Endoscopy_UCTN_Code_TTT_1AO_2AI
Endoscopy_UCTN_Code_TTT_1AO_2AN
Competing interests: None
Fredrik Swahn MD
Division of Surgery
Department of Clinical Science,
Intervention and Technology (CLINTEC)
Karolinska University
Hospital
Huddinge
SE-141 86 Stockholm
Sweden
Fax: +46-08-58586366
Email: fredrik.swahn@karolinska.se
Fredrik Swahn MD
Division of Surgery
Department of Clinical Science,
Intervention and Technology (CLINTEC)
Karolinska University
Hospital
Huddinge
SE-141 86 Stockholm
Sweden
Fax: +46-08-58586366
Email: fredrik.swahn@karolinska.se