CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E308-E312
DOI: 10.1055/s-0043-123932
Case report
Owner and Copyright © Georg Thieme Verlag KG 2018

How familiar are we with decision-making concerning the treatment of perforation after endoscopic mucosal resection (EMR) in the colon? A case report

George Tribonias
Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden
,
Niki Daferera
Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden
,
Margarita-Eleni Manola
Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden
,
Rikard Svernlöv
Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden
,
Simone Ignatova
Department of Clinical Pathology, Linköping University Hospital, Linköping, Sweden
,
Henrik Hjortswang
Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden
› Author Affiliations
Further Information

Publication History

submitted 17 July 2017

accepted after revision 27 October 2017

Publication Date:
01 March 2018 (online)

Abstract

Background and study aims We describe a case of perforation after colonic endoscopic mucosal resection (EMR) that was treated conservatively. We would like to highlight the importance of decision-making mainly based on the endoscopist's point of view in combination with the surgical consultation. Although the radiological imaging is always needed, it cannot solely lead to a decision for operation. Intraperitoneal gas in computed tomography is not always associated with a hole in the endoscopic field and could be possibly explained from a “balloon” phenomenon. The amount of extraluminal air after an EMR does not correlate reciprocally with patient's pain after the procedure. Even though perforation is a radiological diagnosis and endoscopists should be aware of the common post-EMR radiological findings, the surgical examination is mandatory and should be coupled with the endoscopic opinion in order to guide appropriately the treatment in patients with acute pain.