切開・剥離法による穿孔に対しクリップ縫合及び経肛門的イレウス管が有効であった早期S状結腸癌の1例

概要

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A 65 year old man underwent colonoscopy for positive occult blood test. Anapporoximately 30 mm flat elevated granular tumor was detected in the sigmoid colon. Submucosal dissection EMR wasperformed and the tumor was successfully resected en bloc. But colonic perforation was caused by electric hemostasis under submucosal dissection. Endoscopic clip suture was performed immediately and a transanal intraluminal drainage tube was left indwelling for a week after EMR. The colonic perforation improved without peritonitis. The resected specimen was 37×31 mm, and the pathological finding was well-differentiated adenocarcinoma in adenoma without submucosal invasion with negative marigins. Therefore additional surgery was not performed. Submucosal dissection EMR is useful for lateral spreading tumor but has high risk for colonic perforation. Endscopic clip suture and indwelling transanal intraluminal drainage tube can treat colonic perforation without peritonitis or surgical operation.
Japan Gastroenterological Endoscopy Society Kanto Chapterの論文