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Delayed Perforation after Endoscopic Detachable Snare Ligation for Colonic Diverticular Hemorrhage

Takayuki Nagahashi1,2, Koichi Hamada1,3, Yoshinori Horikawa1

  • 1Department of Gastroenterology, Southern-Tohoku General Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|March 22, 2023
PubMed

Insights

A rare complication of endoscopic detachable snare ligation for colonic diverticular hemorrhage is delayed perforation. This case report details a patient who developed perforation eight days after the procedure, highlighting a potential risk associated with this hemostatic technique.

Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Colorectal Surgery

Background:

  • Colonic diverticular hemorrhage is a common cause of lower gastrointestinal bleeding.
  • Endoscopic detachable snare ligation is an effective hemostatic technique for managing active bleeding.
  • Delayed complications after endoscopic interventions require careful consideration.

Observation:

  • A 74-year-old male presented with severe hematochezia due to a bleeding diverticulum in the descending colon.
  • Initial treatment involved endoscopic detachable snare ligation, which successfully controlled the bleeding.
  • Eight days post-procedure, the patient developed abdominal pain and free air was detected on computed tomography (CT).

Findings:

  • Intraoperative colonoscopy during emergency surgery revealed a perforation at the site of the detachable snare ligation.
  • This represents the first reported instance of delayed perforation following endoscopic detachable snare ligation for colonic diverticular hemorrhage.
  • The perforation occurred at the site where the ligation was applied.

Implications:

  • Endoscopic detachable snare ligation, while effective for hemostasis, carries a risk of delayed perforation.
  • Clinicians should be aware of this potential complication and monitor patients accordingly.
  • Further research may be needed to elucidate the mechanisms and incidence of delayed perforation after this endoscopic technique.

Keywords:
colonic diverticular hemorrhagedelayed perforationendoscopic detachable snare ligation

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