J Korean Med Sci.  2013 Apr;28(4):624-627. 10.3346/jkms.2013.28.4.624.

Spontaneous Healing of Gastric Perforation after Endoscopic Ligation for Gastric Varices

• Kim JH
• Ahn HD
• Kwon KA
• Kim YJ
• Chung JW
• Park DK
• Kim JH

• KMID: 1786974
• DOI: http://doi.org/10.3346/jkms.2013.28.4.624

Abstract

Endoscopic variceal ligation (EVL) can be performed as an optional therapy for gastric variceal bleeding if endoscopic sclerotherapy (ES) is not readily available or if practitioners lack experience. EVL using an endoscopic pneumo-activated ligating device was performed on a 53-year-old male patient with liver cirrhosis who presented with hematemesis. Follow-up esophagogastroduodenoscopy (EGD) performed two days after the EVL showed gastric perforation at the EVL-procedure site on the gastric fundus. However, the patient refused emergency surgery, and therefore received only supportive management, including intravenous antibiotics. EGD 10 days later showed healing of the perforation site. This is the first report of a case of gastric variceal bleeding with development of a gastric perforation soon after EVL, which showed complete recovery with conservative therapy and without surgical intervention.

Keyword

Ligation; Hemostasis; Intestinal Perforation; Endoscopy; Varix

MeSH Terms

Endoscopy, Digestive System
Esophageal and Gastric Varices/*surgery
Gastrointestinal Hemorrhage
Humans
Intestinal Perforation/etiology
Ligation/adverse effects
Liver Cirrhosis/diagnosis
Male
Middle Aged
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Endoscopic view showing the ligated gastric varix. This finding indicates successful ligation of the gastric varix at its bleeding site.

• 

  Fig. 2 Endoscopic finding and computed tomographic (CT) image, 2 days after the band ligation. (A) Perforation (arrow) was noted by endoscopy at post-EVL ulcer base on the gastric fundus. (B) Abdominal CT image visualized some air bubbles in the posterior aspect of the stomach fundus.

• 

  Fig. 3 Follow-up endoscopic findings. (A) Healing ulcer on the perforation site of the gastric fundus 10 days later. (B) Complete remission of the perforated site after 3 months.

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