Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report
Abstract Background Perigastric abscess caused by delayed perforation after endoscopic submucosal dissection is a very rare complication. In principle, delayed perforation after endoscopic submucosal dissection is treated surgically. Herein, we report a case of perigastric abscess caused by delayed...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-03785-5 |
| _version_ | 1827984099156951040 |
|---|---|
| author | Shinya Nagae Yoshiaki Kimoto Rikimaru Sawada Koichi Furuta Yohei Ito Nao Takeuchi Syunya Takayanagi Yuki Kano Rindo Ishii Takashi Sakuno Ryoju Negishi Kohei Ono Yohei Minato Takashi Muramoto Ken Ohata |
| author_facet | Shinya Nagae Yoshiaki Kimoto Rikimaru Sawada Koichi Furuta Yohei Ito Nao Takeuchi Syunya Takayanagi Yuki Kano Rindo Ishii Takashi Sakuno Ryoju Negishi Kohei Ono Yohei Minato Takashi Muramoto Ken Ohata |
| author_sort | Shinya Nagae |
| collection | DOAJ |
| description | Abstract Background Perigastric abscess caused by delayed perforation after endoscopic submucosal dissection is a very rare complication. In principle, delayed perforation after endoscopic submucosal dissection is treated surgically. Herein, we report a case of perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection that was treated conservatively, without perforation closure, and in which the patient was discharged from hospital in a short period. Case presentation A-74-year-old Asian man was diagnosed with having early gastric cancer on follow-up endoscopy and was admitted to our hospital for endoscopic resection. Endoscopic submucosal dissection was performed without intraoperative complications. On postoperative day 2, the patient complained of a slight abdominal pain localized to the epigastric region and a small amount of melena. A computed tomography scan revealed the presence of free air in the peritoneal cavity, and a little fluid collection abutting the dorsal area of the stomach. An endoscopy examination showed a deep ulcer with the accumulation of pus, suggesting a perforation in the post-endoscopic submucosal dissection ulcer. We diagnosed a perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, and opted for conservative treatment, leaving the perforation site open to allow spontaneous drainage from the abscess into the stomach. A follow-up computed tomography scan revealed an encapsuled and localized perigastric abscess on postoperative day 5, and the disappearance of the free air and the regression of the perigastric abscess on postoperative day 7. A follow-up endoscopy examination on postoperative day 7 showed the closure of the perforation. Finally, surgery was avoided, and the patient was discharged on postoperative day 14, after a relatively short hospital stay. Conclusion Regarding the treatment of perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, leaving the perforation site open to allow spontaneous drainage may shorten the conservative treatment period. |
| first_indexed | 2024-04-09T22:55:36Z |
| format | Article |
| id | doaj.art-f935da3a35dd4750a46a0c29241fca2e |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-09T22:55:36Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-f935da3a35dd4750a46a0c29241fca2e2023-03-22T11:19:48ZengBMCJournal of Medical Case Reports1752-19472023-03-011711510.1186/s13256-023-03785-5Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case reportShinya Nagae0Yoshiaki Kimoto1Rikimaru Sawada2Koichi Furuta3Yohei Ito4Nao Takeuchi5Syunya Takayanagi6Yuki Kano7Rindo Ishii8Takashi Sakuno9Ryoju Negishi10Kohei Ono11Yohei Minato12Takashi Muramoto13Ken Ohata14Department of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoDepartment of Gastrointestinal Endoscopy, NTT Medical Center TokyoAbstract Background Perigastric abscess caused by delayed perforation after endoscopic submucosal dissection is a very rare complication. In principle, delayed perforation after endoscopic submucosal dissection is treated surgically. Herein, we report a case of perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection that was treated conservatively, without perforation closure, and in which the patient was discharged from hospital in a short period. Case presentation A-74-year-old Asian man was diagnosed with having early gastric cancer on follow-up endoscopy and was admitted to our hospital for endoscopic resection. Endoscopic submucosal dissection was performed without intraoperative complications. On postoperative day 2, the patient complained of a slight abdominal pain localized to the epigastric region and a small amount of melena. A computed tomography scan revealed the presence of free air in the peritoneal cavity, and a little fluid collection abutting the dorsal area of the stomach. An endoscopy examination showed a deep ulcer with the accumulation of pus, suggesting a perforation in the post-endoscopic submucosal dissection ulcer. We diagnosed a perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, and opted for conservative treatment, leaving the perforation site open to allow spontaneous drainage from the abscess into the stomach. A follow-up computed tomography scan revealed an encapsuled and localized perigastric abscess on postoperative day 5, and the disappearance of the free air and the regression of the perigastric abscess on postoperative day 7. A follow-up endoscopy examination on postoperative day 7 showed the closure of the perforation. Finally, surgery was avoided, and the patient was discharged on postoperative day 14, after a relatively short hospital stay. Conclusion Regarding the treatment of perigastric abscess, caused by delayed perforation after endoscopic submucosal dissection, leaving the perforation site open to allow spontaneous drainage may shorten the conservative treatment period.https://doi.org/10.1186/s13256-023-03785-5Endoscopic submucosal dissectionDelayed perforationIntraperitoneal abscessConservative treatmentAdverse effects |
| spellingShingle | Shinya Nagae Yoshiaki Kimoto Rikimaru Sawada Koichi Furuta Yohei Ito Nao Takeuchi Syunya Takayanagi Yuki Kano Rindo Ishii Takashi Sakuno Ryoju Negishi Kohei Ono Yohei Minato Takashi Muramoto Ken Ohata Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report Journal of Medical Case Reports Endoscopic submucosal dissection Delayed perforation Intraperitoneal abscess Conservative treatment Adverse effects |
| title | Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report |
| title_full | Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report |
| title_fullStr | Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report |
| title_full_unstemmed | Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report |
| title_short | Perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection: successful conservative treatment without perforation closure: a case report |
| title_sort | perigastric abscess caused by delayed perforation after gastric endoscopic submucosal dissection successful conservative treatment without perforation closure a case report |
| topic | Endoscopic submucosal dissection Delayed perforation Intraperitoneal abscess Conservative treatment Adverse effects |
| url | https://doi.org/10.1186/s13256-023-03785-5 |
| work_keys_str_mv | AT shinyanagae perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT yoshiakikimoto perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT rikimarusawada perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT koichifuruta perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT yoheiito perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT naotakeuchi perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT syunyatakayanagi perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT yukikano perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT rindoishii perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT takashisakuno perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT ryojunegishi perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT koheiono perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT yoheiminato perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT takashimuramoto perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport AT kenohata perigastricabscesscausedbydelayedperforationaftergastricendoscopicsubmucosaldissectionsuccessfulconservativetreatmentwithoutperforationclosureacasereport |