Endoscopic Vacuum Therapy for Iatrogenic Rectal Perforation

Area of Science:

• Gastroenterology
• Surgical Innovation

Background:

• Iatrogenic bowel injuries, such as rectal perforation during colonoscopy, are rare but serious complications.
• Endoscopic therapy is a potential treatment option for detected perforations, contingent on injury characteristics and local expertise.

Observation:

• A 54-year-old female patient experienced a rectal perforation during screening colonoscopy.
• Emergency endoscopy revealed a 4 cm x 2.5 cm perforation in the lower rectum.
• Due to the defect's depth and risk of abscess formation with clip closure, endoscopic vacuum therapy (EVT) was chosen.

Findings:

• EVT was administered over 7 days, with sponge adjustments and re-evaluations on days 2 and 5.
• The patient remained symptom-free throughout treatment.
• Complete wound closure was achieved, with inflammatory markers normalizing and successful discharge on day 8.

Implications:

• This case demonstrates the successful application of EVT for iatrogenic rectal perforation.
• EVT is a recommended consideration for deep rectal perforations where mechanical closure poses a high risk of abscess formation, especially with signs of systemic inflammation.