Abstract
Background and study aims We report on a case of a traumatic rectal perforation that occurred in a 16-year-old girl, which was successfully treated using an over-the-scope clip, avoiding major surgery and stoma.
Introduction
The over-the-scope clip (OTSC) (Ovesco Endoscopy GmbH, Tübingen, Germany), designed for tissue approximation, is already recommended as first-line endoscopic treatment for endoscopic acute iatrogenic perforation 1 . To the best of our knowledge, no data regarding gastrointestinal traumatic, not iatrogenic, perforation repaired with the use of OTSC, are available.
Case report
Video 1 Full-length video showing the entire successful repair of wide traumatic rectal perforation using OTSC
A 16-year-old girl was referred to the emergency room for copious rectal bleeding and secondary syncope, due to violent trauma. Computed tomography (CT) scan and subsequent colonoscopy revealed a voluminous pelvic hematoma and a 35 – to 40-mm irregular full-thickness defect, located in the posterior rectal wall, about 30 mm from the dentate line ( Fig. 1 ).
Fig. 1 .
35- to 40-mm irregular full-thickness defect of the posterior rectal wall.
Because of the lesion’s features and the acute setting, an OTSC was placed (12 /6 mm, traumatic type) using the OTSC twin grasper (Ovesco Endoscopy GmbH, Tübingen, Germany) ( Fig. 2 ). This auxiliary device has two jaws which can be opened separately, allowing better gaping edges approximation.
Fig. 2.
Edges approximation with OTSC twin grasper.
The entire procedure was performed under deep sedation, using CO 2 insufflation Video 1 .
The endoscopic treatment was effective, as confirmed after contrast medium injection and CT scan.
A Few days later, second endoscopic look confirmed complete sealing of the defect and the patient was discharged home ( Fig. 3 ).
Fig. 3.
Complete sealing of the defect.
Conclusion
In conclusion, OTSC with a twin grasper can successfully treat wide traumatic rectal perforation, avoiding major surgery with definitive or temporary stoma, especially in a young patient.
Footnotes
Competing interests The authors declare that they have no conflict of interest.
Reference
- 1.Paspatis G A, Dumonceau J M, Barthet M et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2014;46:693–711. doi: 10.1055/s-0034-1377531. [DOI] [PubMed] [Google Scholar]