title: Delayed perforation occurring on the 24th day after endoscopic submucosal dissection for early gastric cancer.
abstract: Delayed perforation occurs after 0.5% of endoscopic submucosal dissection (ESD) procedures for early gastric cancer (EGC). This complication can occur within a few hours or days after ESD. There are few reports in the English literature concerning patients who developed delayed perforation after ESD for EGC. An 81-year-old woman was referred to the emergency department of our hospital on the 24th day after ESD because of abdominal pain. We diagnosed her with delayed perforation with peritonitis after ESD for EGC using computed tomography (CT) and esophagogastroduodenoscopy (EGD). We performed primary closure with interrupted sutures covered via pedicled omentoplasty. The patient was discharged 13 days after surgery without any postoperative complications. Delayed perforation is generally treated with conservative, surgical, or endoscopic methods. Several benefits of endoscopic clipping have been reported. However, in the present case, we performed emergency surgery while considering possible fatal complications, such as severe peritonitis. It is important to recognize delayed perforation in the differential diagnosis. The decision to perform surgery should be made after carefully considering the degree of perforation based on EGD, CT findings, and patient conditions.
authors.affiliation: Department of Surgery, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata, 998-8501, Japan. satoru.homma@jfcr.or.jp.|Department of Gastroenterological Surgery, The Cancer Institute Hospital of JFCR, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan. satoru.homma@jfcr.or.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Surgery, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata, 998-8501, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tokodai
authors.affiliation: Department of Surgery, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata, 998-8501, Japan.
authors.forename: Minami
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata, 998-8501, Japan.
authors.forename: Kai
authors.initials: K
authors.lastname: Takaya
authors.affiliation: Department of Surgery, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata, 998-8501, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hashizume
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects* / Q000379:methods; D016145:Endoscopy, Digestive System; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery*; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed
keywords: Delayed perforation; Early gastric cancer; Endoscopic submucosal dissection