Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Soft Tissue Emphysema : Complications of ESD in a Patient with LST of Colon Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon St.Mary’s Hospital

F/ 56 이O희 P/Ix admitted for ESD of a LST-NG of the D colon proven colonoscopically and histopathologically in previous screening colonoscopy . P/MHx non-specific laboratory data and chest radiograph WNL

Endoscopic Submucosal Dissection

dyspnea. chest, face and neck became swollen - R/O subcutaneous emphysema

Endoscopic snaring and clipping Pathology report: tubulo-villous adenoma moderate to severe atypia size 3.0*2.5cm resected margin free from adenoma safty margin 0.3cm

V/S 120/70 - 90 - 18 – 36.6`C P/Ex abdomen soft & flat fluid replacement antibiotics Tx: cefoperazone + metronidazole O2 5L nasal prong close observation

post-ESD day#1 Urgent surgical intervention was planned V/S 120/80 - 96 - 26 - 37.4`C dyspnea, abdominal pain P/Ex board-like rigidity + ABGA 7.31- 44- 61- 22- 88% Urgent surgical intervention was planned

post-ESD day#1 laparoscopic segmentectomy of the descending colon was performed. resection margin : proximal 7cm distal 12cm mesenteric margin 6.5cm

post-ESD D#1 POD #4

Review

When perforation occurs in the retroperitoneal colon, air may traverse the diaphragm and progress to the medi-astinum and neck via the visceral space. Currently endoscopic closure is considered as a first line treatment strategy with low morbidity and mortality in pati-ents without peritoneal irritation.1 there was a recent report that successful closure rate of endoscopic clipping was about 70%.2 Surgical intervention, however, should be considered when the patient’s clinical condition is deteriorated despit-e adequate management. Endoscopy. 2009;41:941-951. 1 J Gastroenterol Hepatol. 2007;22:1409-1414.2