SUCCESSFUL REPAIR OF WIDE TRAUMATIC RECTAL PERFORATION USING OVER-THE-SCOPE CLIP (OTSC)

The over-the-scope clip (OTSC, Ovesco Endoscopy GmbH, Tübingen, Germany), designed for tissue approximation, is already recommended as first-line endoscopic treatment for endoscopic acute iatrogenic perforation [1].

To the best of our knowledge, no data regarding gastrointestinal traumatic perforation are available.

A 16-year-old girl referred to emergency room for copious rectal bleeding and secondary syncope, due to violent trauma.

Computed tomography (CT) scan and subsequent colonoscopy revealed a voluminous pelvic hematoma and a 35 – 40 mm irregular full-thickness defect, located in the posterior rectal wall, about 30 mm from the dentate line.

Because of the lesion's features and the acute setting, an OTSC was placed (12/6 mm, traumatic type) using the OTSC twin grasper (Ovesco Endoscopy GmbH, Tübingen, Germany). This auxiliary device has two jaws which can be opened separately, allowing better gaping edges approximation.

The entire procedure was performed under deep sedation, using CO₂ insufflation.

The endoscopic treatment was effective, as confirmed after contrast medium injection and CT scan.

Few days later, second endoscopic look confirmed complete sealing of the defect and the patient was discharged home [video].

In conclusion, OTSC with twin grasper can successfully treat wide traumatic rectal perforation, avoiding major surgery with definitive or temporary stoma, especially in a young woman.

Reference

1. Paspatis G.A., Dumonceau J.M., Barthet M et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2014;46:693 – 711.