Microperforation after colonic endoscopic submucosal dissection, air in 5 separate locations

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Endoscopic submucosal dissection (ESD) and endoscopic mucosal dissection (EMD) are standard endoscopic treatments for gastrointestinal mucosal lesions.
• While generally safe, these procedures carry inherent risks of complications, even when performed by experienced endoscopists.

Observation:

• A 58-year-old male presented with an intramucosal carcinoma in the proximal descending colon, treated with ESD.
• Following the procedure, the patient developed an unusual cluster of complications: bilateral pneumothoraxes, pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and pneumoderma.

Findings:

• The simultaneous occurrence of multiple air-related complications post-ESD is exceedingly rare.
• This case underscores the potential for unexpected and diverse adverse events following endoscopic submucosal dissection.

Implications:

• Increased awareness of rare ESD complications is crucial for timely diagnosis and management.
• Highlighting such comprehensive complication profiles aids in refining patient safety protocols and surgical techniques in interventional endoscopy.