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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 5  |  Issue : 6  |  Page : 399-400

Closure of echoendoscope-related duodenal free wall perforation by placement of a covered metallic stent


1 Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
2 Department of Radiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey

Date of Submission23-Dec-2015
Date of Acceptance03-Jun-2016
Date of Web Publication15-Dec-2016

Correspondence Address:
Dr. Ufuk Barış Kuzu
Ankara Yuksek İhtisas Eğitim ve Araştırma Hastanesi Gastroenteroloji Servisi, Kızılay SK. No: 4 Sıhhiye Altındağ, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.195874

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How to cite this article:
Disibeyaz S, Öztaş E, Kuzu UB, Özdemir M. Closure of echoendoscope-related duodenal free wall perforation by placement of a covered metallic stent. Endosc Ultrasound 2016;5:399-400

How to cite this URL:
Disibeyaz S, Öztaş E, Kuzu UB, Özdemir M. Closure of echoendoscope-related duodenal free wall perforation by placement of a covered metallic stent. Endosc Ultrasound [serial online] 2016 [cited 2022 Jul 1];5:399-400. Available from: http://www.eusjournal.com/text.asp?2016/5/6/399/195874

Dear Editor,

An eighty-two year-old female patient was admitted to our clinic with complaints of jaundice and weight loss. Due to suspicion of the periampullary tumor, endoscopic ultrasonography (EUS) was performed. During EUS, it was seen that postbulbar area of the duodenum was narrowed and angulated; passage of echoendoscope through this area was difficult. Due to rapid deterioration of patient's vital signs, the EUS was terminated early without adequate evaluation of the periampullary region. Approximately 2 h later, computed tomography (CT) was performed because of severe abdominal pain. On CT scan, intra- and retro-peritoneal air was seen without fluid collection [Figure 1]a. Endoscopic examination was performed with forward-view endoscope, and a perforation with a diameter of 2.5 cm was observed at the inferior part of the postbulbar area [Figure 1]b. Due to her age, poor medical condition, and high suspicion of malignancy, the patient was not considered a surgical candidate. Initially, over-the-scope-clip was tried but it failed to close the defect because of angulation and larger size. A 80 cm × 20 mm fully covered self-expandable metallic duodenal stent (FCSEMS) was placed through the perforation site under the fluoroscopic condition [Figure 1]c and d. She was treated with total parenteral nutrition for 6 weeks and broad-spectrum antibiotics for 3 weeks, and also repeat-CT examinations were performed during the follow-up period. Acute cholangitis was developed at 2 nd week, and external biliary drainage was applied through percutaneous transhepatic way. At 6 th week, the CT findings were completely resolved [Figure 1]e and FCSEMS was extracted endoscopically and it was observed that, the perforation site was obliterated [Figure 1]f.
Figure 1. (a) Computed tomography scan showing the presence of air in the intra- and retro-peritoneal space (arrows) (b) Image on endoscopic examination was performed with forward-view endoscope and perforation site measuring 2.5 cm in diameter was seen at the inferior part of the postbulbar area. (c) Image while the FCSEMS is opening; in addition, free gas in the retroperitoneal space and over-the-scope clip are seen. (d) The FCSEMS is placed through the perforation site. (e) At 6th week, the computed tomography findings were completely resolved. In addition, FCSEMS is seen (arrows). (f) The perforation site was obliterated at the 6th week of the procedure after the displacement of FCSEMS. FCSEMS: Fully covered self-expandable metallic duodenal stent

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Albeit the use of FCSEMS is widely recommended as one of the endoscopic treatment options as an expert opinion in iatrogenic endoscope-related duodenal free wall perforations,[1],[2],[3],[4] this is the first reported case with echoendoscope-related duodenal free wall perforation who had been successfully treated by placement of covered metallic stent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Baron TH, Wong Kee Song LM, Zielinski MD, et al. A comprehensive approach to the management of acute endoscopic perforations (with videos). Gastrointest Endosc 2012;76:838-59.  Back to cited text no. 1
    
2.
Boumitri C, Kumta NA, Patel M, et al. Closing perforations and postperforation management in endoscopy: duodenal, biliary, and colorectal. Gastrointest Endosc Clin N Am 2015;25:47-54.  Back to cited text no. 2
    
3.
Lee TH, Han JH, Park SH. Endoscopic treatments of endoscopic retrograde cholangiopancreatography-related duodenal perforations. Clin Endosc 2013;46:522-8.  Back to cited text no. 3
    
4.
Kumbhari V, Khashab A. Perforation due to ERCP. Tech Gastrointest Endosc 2014;16:187-94.  Back to cited text no. 4
    


    Figures

  [Figure 1]


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