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DOI: 10.1055/a-2163-2290
Iatrogenic colorectal perforation caused by a clip
An iatrogenic colonic perforation (ICP) is a significant incident associated with colonoscopy, with recent guidelines detailing a treatment-related incidence of 0.02 %–8 % [1]. Although clips are frequently used to suture perforations [2], ICPs caused by the clips themselves have not previously been reported. Here, we describe a case of an ICP occurring during endoscopic treatment that was caused by a clip in a colonic diverticulum.
A man aged in his eighties was referred to our hospital for treatment of colonic polyps. Colonoscopy revealed multiple colonic diverticula in the sigmoid colon. A trainee with less than 1 year of experience had attempted to use a clip to close the ulcer after endoscopic mucosal resection of a 5-mm Is polyp in the patient’s sigmoid colon. During the procedure, the scope was frequently pulled out toward the anal side owing to enhanced peristaltic spasm of the colon. During reinsertion with the clip opened, a laceration occurred in the mucosa because the metal part of the tip of the clip got caught in a small depression of a colonic flexure ([Fig. 1 a]; [Video 1]). No muscular layer was observed in the mucosal defect, consistent with a diagnosis of perforation at the diverticular site ([Fig. 1 b]). The wound was completely closed with clips ([Fig. 1 c]). A computed tomography (CT) scan of the abdomen taken after the examination showed air leakage outside of the colon ([Fig. 2]). The patient was discharged after 1 week of conservative treatment.
Video 1 Iatrogenic colorectal perforation at a diverticulum caused by a clip that was being placed following endoscopic mucosal resection performed by a trainee.
Quality:
We report a case of ICP at a colonic diverticulum caused by a metal clip tip. As has been previously reported in endoscopic treatment of tumors involving diverticula, diverticula lack or have a thin muscle layer [3] [4]. Devices such as clips should be retracted into the forceps channel of the endoscope or the attachment hood before their insertion into the flexure of the colon, especially in patients with diverticula.
Endoscopy_UCTN_Code_CPL_1AJ_2AG
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Publication History
Article published online:
06 October 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
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- 2 Magdeburg R, Collet P, Post S. et al. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2008; 22: 1500-1504
- 3 Fu KI, Hamahata Y, Tsujinaka Y. Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy. World J Gastroenterol 2010; 16: 1545-1547
- 4 Ikezawa N, Toyonaga T, Tanaka S. et al. Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum. Clin Endosc 2022; 55: 417-425