Endoscopic suturing of a large type I duodenal perforation

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Endoscopic suturing of a large type I duodenal perforation Jong Jin Hyun, MD, PhD, Richard A. Kozarek, MD, Shayan S. Irani, MD VideoGIE Volume 4, Issue 2, Pages 78-80 (February 2019) DOI: 10.1016/j.vgie.2018.04.008 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 CT view showing dilatation of both the bile and pancreatic ducts (“double-duct sign,” open arrows) with a possible lesion in the periampullary area. VideoGIE 2019 4, 78-80DOI: (10.1016/j.vgie.2018.04.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 EUS view showing thickening of the distal common bile duct without distinct mass (arrow). VideoGIE 2019 4, 78-80DOI: (10.1016/j.vgie.2018.04.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Attempt to dilate the duodenal stricture with controlled radial expansion balloon. VideoGIE 2019 4, 78-80DOI: (10.1016/j.vgie.2018.04.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 (A, B) Peritoneal fat observed during advancement of the endoscope, consistent with full-thickness perforation. VideoGIE 2019 4, 78-80DOI: (10.1016/j.vgie.2018.04.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 A small outpouching (arrow) noted near the suture site on upper-GI series. VideoGIE 2019 4, 78-80DOI: (10.1016/j.vgie.2018.04.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 Free air around the perforation site without substantial fluid collection. VideoGIE 2019 4, 78-80DOI: (10.1016/j.vgie.2018.04.008) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions