Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Case of a Successful Band Ligation of a Colonic Perforation during Diagnostic Colonoscopy

내시경 밴드 결찰술로 치료한 대장천공 1예

  • Lee, Heon-Nam (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Kim, Eui-Joo (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Park, Sung-Keun (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Seo, Mi-Ryoung (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Lee, Jong-Joon (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Lee, Young-Jun (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Oh, Kyong-Yong (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science) ;
  • Park, Dong-Gun (Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science)
  • 이헌남 (가천의과학대학교 길병원 내과학교실) ;
  • 김의주 (가천의과학대학교 길병원 내과학교실) ;
  • 박성근 (가천의과학대학교 길병원 내과학교실) ;
  • 서미령 (가천의과학대학교 길병원 내과학교실) ;
  • 이종준 (가천의과학대학교 길병원 내과학교실) ;
  • 이영준 (가천의과학대학교 길병원 내과학교실) ;
  • 오경용 (가천의과학대학교 길병원 내과학교실) ;
  • 박동균 (가천의과학대학교 길병원 내과학교실)
  • Received : 2010.05.28
  • Accepted : 2010.07.30
  • Published : 2010.09.30
⟨ Previous Next ⟩

Abstract

Colonoscopy is a relatively safe tool for diagnosis and treatment of colorectal disease. But colonic perforation during colonoscopy is a severe complication and sometimes becomes a life-threatening condition. It occurs with a frequency of 0.07% among patients having diagnostic colonoscopy and in up to 0.40% of patients having therapeutic colonoscopy. In these cases, surgical treatment is needed but endoscopic repair and conservative management could reduce the need for immediate operations. Endoscopic clipping has been the principal method for non-operative treatment of iatrogenic colonic perforation, but it has important limitations. One of them is that it is technically difficult to clip when the angle of approach is tangential. Here we report a case of an iatrogenic colonic perforation treated with endoscopic band ligation rather than endoscopic clipping, because of approach difficulties.

대장내시경은 비교적 안전한 검사이나 드물게 발생하는 대장천공이 문제가 될 수 있다. 대장천공의 치료에 있어서 고전적인 방법인 수술 대신 내시경 클립술을 이용한 보존적인 치료에 대한 연구가 이어지고 있으나 클립의 구조적인 한계 및 내시경과 천공부위가 이루는 각도로 인해 클립술이 어려운 경우가 있다. 저자들은 내시경과 천공부위가 평행하여 클립술이 어려웠던 구불결장 천공 환자에서 밴드 결찰술을 시행하여 봉합에 성공하였으며 이를 문헌고찰과 함께 보고한다.

Keywords

References

  1. Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 2002;55:307-314. https://doi.org/10.1067/mge.2002.121883
  2. Kavic SM, Basson MD. Complications of endoscopy. Am J Surg 2001;181:319-332. https://doi.org/10.1016/S0002-9610(01)00589-X
  3. Kang HY, Kang HW, Kim SG, et al. Incidence and management of colonoscopic perforations in Korea. Digestion 2008;78:218-223. https://doi.org/10.1159/000190811
  4. Yoshikane H, Hidano H, Sakakibara A, et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 1997;46:464-466. https://doi.org/10.1016/S0016-5107(97)70045-2
  5. Magdeburg R, Collet P, Post S, Kaehler G. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2008;22:1500-1504. https://doi.org/10.1007/s00464-007-9682-1
  6. Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 2010;16:425-430. https://doi.org/10.3748/wjg.v16.i4.425
  7. Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 2009;41:941-951. https://doi.org/10.1055/s-0029-1215179
  8. Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc 2009;69:654-664. https://doi.org/10.1016/j.gie.2008.09.008
  9. Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 2000;95:3418-3422. https://doi.org/10.1111/j.1572-0241.2000.03356.x
  10. Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007;21:994-997. https://doi.org/10.1007/s00464-007-9251-7
  11. Oh JE, Shim SG. Colonoscopic perforation; a 10-year experience in single general hospital. Korean J Gastroenterol 2009;54:371-376. https://doi.org/10.4166/kjg.2009.54.6.371
  12. Carpio G, Albu E, Gumbs MA, Gerst PH. Management of colonic perforation after colonoscopy. Report of three cases. Dis Colon Rectum 1989;32:624-626. https://doi.org/10.1007/BF02554186
  13. Orsoni P, Berdah S, Verrier C, et al. Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy 1997;29:160-164. https://doi.org/10.1055/s-2007-1004156
  14. Lo AY, Beaton HL. Selective management of colonoscopic perforations. J Am Coll Surg 1994;179:333-337.
  15. Damore LJ 2nd, Rantis PC, Vernava AM 3rd, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 1996;39:1308-1314. https://doi.org/10.1007/BF02055129
  16. Fujishiro M, Yahagi N, Kakushima N, et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy 2006;38:1001-1006. https://doi.org/10.1055/s-2006-944775
  17. Kim JI, Kim SS, Park S, et al. Endoscopic hemoclipping using a transparent cap in technically difficult cases. Endoscopy 2003;35:659-662. https://doi.org/10.1055/s-2003-41512