Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer
Abstract Various complications of colorectal endoscopic submucosal dissection (ESD) have been reported, including bleeding, penetration, perforation, and coagulation syndrome. However, the occurrence of bowel obstruction after ESD is rare. We report a case of adhesive bowel obstruction after ESD for...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-04-01
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| Series: | DEN Open |
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| Online Access: | https://doi.org/10.1002/deo2.194 |
| _version_ | 1827957619981025280 |
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| author | Kenta Seki Taku Sakamoto Mai Ego Makiguchi Naoya Toyoshima Hiroyuki Takamaru Masau Sekiguchi Masayoshi Yamada Shigeki Sekine Yukihide Kanemitsu Yutaka Saito |
| author_facet | Kenta Seki Taku Sakamoto Mai Ego Makiguchi Naoya Toyoshima Hiroyuki Takamaru Masau Sekiguchi Masayoshi Yamada Shigeki Sekine Yukihide Kanemitsu Yutaka Saito |
| author_sort | Kenta Seki |
| collection | DOAJ |
| description | Abstract Various complications of colorectal endoscopic submucosal dissection (ESD) have been reported, including bleeding, penetration, perforation, and coagulation syndrome. However, the occurrence of bowel obstruction after ESD is rare. We report a case of adhesive bowel obstruction after ESD for a laterally spreading tumor in the sigmoid colon. The 35‐mm tumor was successfully removed by ESD without intraoperative complications. The patient had a fever, lower abdominal pain, and a small amount of bloody stool the day after ESD. Endoscopy revealed minor bleeding from the ESD scar, which was treated by hemostatic clips. Pathological analysis showed adenocarcinoma was exposed to the vertical margin; therefore, the resection was non‐curative. At 39 days after ESD and 36 days after discharge, the patient had abdominal pain and nausea. She was readmitted with a diagnosis of adhesive bowel obstruction. Conservative treatment was ineffective; therefore, she underwent sigmoidectomy combined with partial resection of the small intestine because of small intestinal stenosis caused by inflammation. The pathological examination showed localized peritonitis around the sigmoid colon where ESD was performed. There was more fibrosis along the serous surface of the small intestine than on the sigmoid colon. We concluded that there was a micro‐perforation that could not be detected by endoscopy or physical examination. This case indicates that adhesive bowel obstruction may occur as a complication of ESD. |
| first_indexed | 2024-04-09T15:22:51Z |
| format | Article |
| id | doaj.art-aa29f70bedd14feaadf7702f9f380b47 |
| institution | Directory Open Access Journal |
| issn | 2692-4609 |
| language | English |
| last_indexed | 2024-04-09T15:22:51Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj.art-aa29f70bedd14feaadf7702f9f380b472023-04-29T05:12:58ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.194Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancerKenta Seki0Taku Sakamoto1Mai Ego Makiguchi2Naoya Toyoshima3Hiroyuki Takamaru4Masau Sekiguchi5Masayoshi Yamada6Shigeki Sekine7Yukihide Kanemitsu8Yutaka Saito9Endoscopy Division National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanDepartment of Diagnostic Pathology National Cancer Center Tokyo JapanDepartment of Colorectal Surgery National Cancer Center Tokyo JapanEndoscopy Division National Cancer Center Tokyo JapanAbstract Various complications of colorectal endoscopic submucosal dissection (ESD) have been reported, including bleeding, penetration, perforation, and coagulation syndrome. However, the occurrence of bowel obstruction after ESD is rare. We report a case of adhesive bowel obstruction after ESD for a laterally spreading tumor in the sigmoid colon. The 35‐mm tumor was successfully removed by ESD without intraoperative complications. The patient had a fever, lower abdominal pain, and a small amount of bloody stool the day after ESD. Endoscopy revealed minor bleeding from the ESD scar, which was treated by hemostatic clips. Pathological analysis showed adenocarcinoma was exposed to the vertical margin; therefore, the resection was non‐curative. At 39 days after ESD and 36 days after discharge, the patient had abdominal pain and nausea. She was readmitted with a diagnosis of adhesive bowel obstruction. Conservative treatment was ineffective; therefore, she underwent sigmoidectomy combined with partial resection of the small intestine because of small intestinal stenosis caused by inflammation. The pathological examination showed localized peritonitis around the sigmoid colon where ESD was performed. There was more fibrosis along the serous surface of the small intestine than on the sigmoid colon. We concluded that there was a micro‐perforation that could not be detected by endoscopy or physical examination. This case indicates that adhesive bowel obstruction may occur as a complication of ESD.https://doi.org/10.1002/deo2.194adhesive bowel obstructionendoscopic submucosal dissectionmicro‐perforationpost‐ESD coagulation syndromesigmoid colon |
| spellingShingle | Kenta Seki Taku Sakamoto Mai Ego Makiguchi Naoya Toyoshima Hiroyuki Takamaru Masau Sekiguchi Masayoshi Yamada Shigeki Sekine Yukihide Kanemitsu Yutaka Saito Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer DEN Open adhesive bowel obstruction endoscopic submucosal dissection micro‐perforation post‐ESD coagulation syndrome sigmoid colon |
| title | Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer |
| title_full | Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer |
| title_fullStr | Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer |
| title_full_unstemmed | Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer |
| title_short | Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer |
| title_sort | unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer |
| topic | adhesive bowel obstruction endoscopic submucosal dissection micro‐perforation post‐ESD coagulation syndrome sigmoid colon |
| url | https://doi.org/10.1002/deo2.194 |
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