Clin Endosc.  2022 Mar;55(2):292-296. 10.5946/ce.2021.005.

Endoscopic Treatment of Iatrogenic Perforation of Sigmoid Diverticulum: A Case Report of Multidisciplinary Management

• Rizzo GEM
• Ferro G
• Rizzo G
• Carlo GD
• Cantone A
• Vita GGD
• Sciumè C

• KMID: 2527575
• DOI: http://doi.org/10.5946/ce.2021.005

Abstract

Iatrogenic perforations are severe complications of gastrointestinal endoscopy; therefore, their management should be adequately planned. A 77-year-old man with a history of diverticulosis underwent a colonoscopy for anemia. During the procedure, an iatrogenic perforation occurred suddenly in the sigmoid colon, near a severe angle among the numerous diverticula. Through-the- scope clips were immediately applied to treat it and close mucosal edges. Laboratory tests showed increased inflammation and infection, and although there were no complaints of abdominal pain, the patient had an extremely distended abdomen. A multidisciplinary board began management based on a conservative approach. Pneumoperitoneum was treated with computed tomography-assisted drainage. After 72 hours, his intestinal canalization and laboratory tests were normal. Though this adverse event is rare, a multidisciplinary board should be promptly gathered upon occurrence, even if the patient appears clinically stable, to consider a conservative approach and avoid surgical treatment.

Keyword

Colonoscopy; Diverticulum; Endoscopy; Intestinal perforation

Figure

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  Fig. 1. Endoscopic view of the iatrogenic perforation. Colonoscopy shows the breach in diverticulum of sigmoid colon. The breach is characterized by an hole and peritoneal tissue.

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  Fig. 2. (A, B) Plain coronal and sagittal x-ray views show pneumoperitoneum. (C) Abdominal computed tomography scan shows pneumoperitoneum and the clips in sigmoid colon (arrow).

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  Fig. 3. Abdominal computed tomography scan after drainage of pneumoperitoneum. (A) View of clips in the sigmoid colon (arrow). (B) Point of insertion of Veres needle (arrow).

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