Endoscopic Management of an Iatrogenic Colonic Perforation Using Standard Hemoclips

AbstractIatrogenic colonic perforation is an unusual but life‑threatening complication of colonoscopy. The recent advancement in endoscopy technology has made nonoperative treatment a safe and effective option for managing such perforations. A 70‑year‑old man sustained an iatrogenic sigmoid perforation during diagnostic colonoscopy. The abdominal X‑ray showed free gas under diaphragm. He was started on conservative management and intravenous antibiotics. He underwent a second colonoscopy after 2.5‑h, perforation was identified and closed with standard hemoclips. He recovered well and was discharged from hospital 6 days later. There are only a handful of reports in the medical literature describing successful outcomes following endoscopic management. Most of the cases have been managed with over‑the‑scope clips or endoscopic sutures that are quite expensive. In the present report, an iatrogenic sigmoid perforation was managed endoscopically with standard hemoclips. The hemoclip can be an effective, yet economical method of perforation repair in selected cases.

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Tension Pneumothorax, Pneumoperitoneum, and Cervical Emphysema following a Diagnostic Colonoscopy

Case Reports in Emergency Medicine ◽

10.1155/2013/583287 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Ali Pourmand ◽

Hamid Shokoohi

Keyword(s):

Rare Case ◽

Tension Pneumothorax ◽

Colonic Perforation ◽

Tube Thoracostomy ◽

Diagnostic Colonoscopy ◽

Rare Case Report ◽

Initial Injury ◽

Life Threatening ◽

Life Threatening Complication ◽

Anatomical Connection

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence of colonic perforation. This patient developed a simultaneous pneumoperitoneum, pneumomediastinum, and a tension pneumothorax requiring immediate tube thoracostomy. This case may raise the awareness on the likelihood of these serious complications after colonoscopy.

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Migration of catheter of a totally implantable venous access port to right thoracic cavity in a child - a case report

10.21203/rs.3.rs-146991/v1 ◽

2021 ◽

Author(s):

Qiteng Xu ◽

Yueyi Ren ◽

Yifei Hu ◽

Shuhua Duan ◽

Rui Chen ◽

...

Keyword(s):

Venous Access ◽

Thoracic Cavity ◽

Severe Condition ◽

Access Port ◽

Intravenous Antibiotics ◽

Catheter Tip ◽

Life Threatening ◽

Venous Access Port ◽

And Migration ◽

The Right

Abstract BackgroundThe totally implantable venous access port (TIVAP) is a secure and practical choice for children undergoing long-term chemotherapy. Nevertheless, various complications still need to be treated cautiously. Among the complications, the migration of catheters to the thoracic cavity is a very rare (but potentially severe) condition that may necessitate device reimplantation. Furthermore, this migration may even be life-threatening if it is not detected in time.Case presentationA 1-year-old girl undergoing palliative chemotherapy underwent TIVAP placement via the right internal jugular vein. During the operating procedure, the catheter tip was located in the right atrium, which was confirmed by the use of C-arm. Prophylactic intravenous antibiotics were then adopted with routine aspiration and with flushing being conducted each time before administration. Massive right pleural effusion and migration of the catheter tip to the right thoracic cavity were detected on the 2nd day after implantation, which resulted in the removal and reimplantation of the TIVAP device.ConclusionsThe migration of the catheter into the thoracic cavity should be considered a possible complication of TIVAP implantation in children. Early detection and reimplantation may provide opportunities for the prevention of further severe complications.

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Endoscopic Management of Portal Hypertension

International Journal of Hepatology ◽

10.1155/2012/747095 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Said A. Al-Busafi ◽

Peter Ghali ◽

Philip Wong ◽

Marc Deschenes

Keyword(s):

Portal Hypertension ◽

Endoscopic Ultrasound ◽

Capsule Endoscopy ◽

Interventional Therapy ◽

Gastric Varices ◽

Active Management ◽

Endoscopic Management ◽

Diagnostic Modality ◽

Gastroesophageal Varices ◽

Life Threatening

Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.

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Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2010.92.7.555 ◽

2010 ◽

Vol 92 (7) ◽

pp. 555-558 ◽

Cited By ~ 8

Author(s):

Mark Lynch ◽

Seshadri Sriprasad ◽

Kesavapillai Subramonian ◽

Peter Thompson

Keyword(s):

Transurethral Resection ◽

Postoperative Bleeding ◽

Endoscopic Management ◽

Wide Spread ◽

Postoperative Haemorrhage ◽

Post Surgery ◽

Life Saving ◽

Prophylactic Measures ◽

Life Threatening ◽

Life Threatening Complication

INTRODUCTION Intractable haemorrhage after endoscopic surgery, including transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP), is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention. PATIENTS AND METHODS We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding. RESULTS Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed. CONCLUSIONS Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent bleeding post-endoscopic prostatic surgery should be treated promptly to prevent the risk of rapid deterioration. We demonstrated that the technique of open prostate packing may be life-saving.

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Splenic Rupture: An Unusual Complication of Colonoscopy

The American Surgeon ◽

10.1177/000313480707300417 ◽

2007 ◽

Vol 73 (4) ◽

pp. 393-396 ◽

Cited By ~ 2

Author(s):

Stefan Holubar ◽

Amit Dwivedi ◽

J. Eisendorfer ◽

R. Levine ◽

R. Strauss

Keyword(s):

Hemorrhagic Shock ◽

Splenic Injury ◽

Early Recognition ◽

Rare Complication ◽

Treatment Options ◽

Unusual Complication ◽

Angiographic Embolization ◽

Diagnostic Colonoscopy ◽

Life Threatening ◽

Therapeutic Colonoscopy

Splenic injury is a known, albeit rare, complication of diagnostic and therapeutic colonoscopy. Within a 6-month period, we observed two colonoscopic splenic injuries. We report these two cases of splenic injury who presented differently after colonoscopy: one presented as frank hemorrhagic shock, and the other as a subacute splenic hemorrhage with symptomatic anemia. The first patient presented with hemorrhagic shock several hours after a diagnostic colonoscopy and required an emergency splenectomy. The second patient presented with symptomatic anemia several days after a diagnostic colonoscopy and was treated by angiographic embolization. Clinical presentation and discussion of the mechanisms of injury, available treatment options, and strategies for preventing colonoscopic splenic injuries are presented. Awareness of this complication is paramount in early recognition and management of this potentially life-threatening injury.

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Thoracic aortic aneurysm causing aorto-esophageal fistula—our experience with a rare disease

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa242 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Aakriti Yadav ◽

Uttam Krishna Shrestha ◽

Kajan Raj Shrestha ◽

Dinesh Gurung

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Sudden Onset ◽

Massive Hemoptysis ◽

Esophageal Fistula ◽

Feeding Jejunostomy ◽

Intravenous Antibiotics ◽

Threatening Condition ◽

Life Threatening ◽

Upper Gastrointestinal

Abstract Aorto-esophageal fistula is a life-threatening condition, accounting for a small number of cases of upper gastrointestinal bleeding where patients present with one or more features of Chiari’s triad. We present the case of a 43-year-old woman, referred to us with symptoms of central chest pain, sudden onset dysphagia followed by massive hemoptysis. She was diagnosed with an aorto-esophageal fistula due to a ruptured thoracic aortic aneurysm and rushed for an emergency endovascular thoracic aortic stent and feeding jejunostomy with intravenous antibiotics and supportive care. After 6 weeks of surgery, the patient was re-evaluated to plan for an esophageal stent if required. The purpose of this presentation is to make the surgical fraternity aware of the gravity of this disease and novel techniques to manage it.

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Endoscopic management of duodenal fistula in a patient operated after abdominal injury

Polish Journal of Surgery ◽

10.5604/01.3001.0013.1029 ◽

2019 ◽

Vol 91 (3) ◽

pp. 1-4

Author(s):

Bartłomiej Jędrzejczak ◽

Piotr Bednarski ◽

Michał Spychalski ◽

Przemysław Lipiński ◽

Adam Dziki ◽

...

Keyword(s):

High Risk ◽

Conservative Treatment ◽

Endoscopic Management ◽

Duodenal Fistula ◽

Duodenal Injury ◽

Endoscopic Techniques ◽

Life Threatening ◽

Post Traumatic ◽

Duodenal Injuries ◽

Rare Group

Post-traumatic duodenal injuries constitute a relatively rare group among this type of lesions reported in the abdominal structures. In the vast majority of cases, a post-traumatic duodenal injury is accompanied by damage to other important organs. The surgical management of duodenum injuries poses a high risk of life-threatening complications with duodenal fistula among the most common. In some cases, the combination of basic and advanced surgical procedures and intensive conservative treatment is insufficient to treat the complication. The progress in endoscopic techniques and the application of modern instruments have allowed for the use of these procedures to manage gastrointestinal injuries of various aetiology. The aim of the study is to present an effective endoscopic occlusion of post-traumatic duodenal fistula.

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Chemotherapy-induced febrile neutropenia (FN) and FN prevention strategies in cancer care in the U.S. Veterans Health Administration (VHA).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6608 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6608-6608 ◽

Cited By ~ 2

Author(s):

Richard L. Barron ◽

Li Wang ◽

Onur Baser ◽

Wendy J. Langeberg ◽

David C. Dale

Keyword(s):

Veterans Health ◽

Health Administration ◽

Inpatient Mortality ◽

Prevention Strategies ◽

Fully Integrated ◽

Non Hodgkin Lymphoma ◽

Intravenous Antibiotics ◽

Life Threatening ◽

Hospital Stays ◽

Related Mortality

6608 Background: Chemo-induced FN can be a life-threatening adverse event requiring immediate hospitalization and is associated with increased infection-related mortality and healthcare costs. Because the VHA has a fully-integrated national claims database, we used this database to assess FN incidence, burden, and prevention strategies in VA cancer patients. Methods: VHA’s database includes de-identified inpatient, outpatient, pharmacy, and laboratory claims and EMR data. Patients ≥ 18 years old with lung, colorectal (CRC), or prostate cancer or non-Hodgkin lymphoma (NHL) who had initiated ≥ 1 course of myelosuppressive chemo from Jan 2006–Sept 2011 were included. Endpoints included chemo treatment patterns and FN incidence, burden (inpatient mortality, length of stay [LOS], and costs), and prophylaxis. FN was identified based on ICD-9-CM codes for neutropenia. Prophylaxis was defined as first use of any granulocyte colony-stimulating factor (G-CSF) or intravenous antibiotics within 5 days of chemo administration or oral antibiotics within 7 days before and 6 days after chemo administration in any cycle. Costs were estimated using hospital and laboratory claims containing an FN diagnosis. Results: 27,899 patients were eligible and were included in the analysis. Most were ≥ 65 years old (56%) and male (98%). See Table for selected endpoints. Conclusions: FN was a common event, and patients with FN had lengthy hospital stays, high inpatient mortality rates, and considerable costs. In the VHA, antibiotic prophylaxis was generally used more frequently than G-CSF prophylaxis. [Table: see text]

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