Colonic microperforation after endoscopic piecemeal mucosal resection

Abstract

A 45-year-old woman had an Is + IIa laterally spreading tumor (granular type), 30 mm in size, located in the lower rectum. This lesion was removed by endoscopic piecemeal mucosal resection (EPMR) combined with argon plasma coagulation. The area of the defect after EPMR was completely closed with endoscopic clipping to avoid delayed bleeding and perforation. Perforation, such as tearing of the muscle layer, was not recognized during EPMR. However, abdominal radiography, which the authors perform routinely after EPMR, showed free air near the rectum. The patient did not complain of abdominal pain except for anal discomfort, and conservative treatment with antibiotics was selected. The surgeon inserted a tube from the anus to prevent expansion of the rectum and to keep unwanted digestive juices from leaking out from the damaged area. The maximum C-reactive protein level was 17.2 mg/dL 2 days after EPMR, and on day 6 was <1.0 mg/dL. An oral diet was resumed, and the patient was discharged at 8 days after the EMR. © 2007 The Authors.