Perigastric Abscess as a Complication of Endoscopic Submucosal Dissection for Early Gastric Cancer: First Case Report

Ji Yun Jung; Joon Sung Kim; Byung-Wook Kim; Sung Min Park; Gi Jun Kim; Seung Ji Ryu; Young Wook Kim; Jeong Seon Ji; Hwang Choi

doi:10.4166/kjg.2016.67.3.142

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Jung, Kim, Kim, Park, Kim, Ryu, Kim, Ji, and Choi: Perigastric Abscess as a Complication of Endoscopic Submucosal Dissection for Early Gastric Cancer: First Case Report

Case Report

Korean J Gastroenterol 2016;67(3):142-145.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.67.3.142

Perigastric Abscess as a Complication of Endoscopic Submucosal Dissection for Early Gastric Cancer: First Case Report

Ji Yun Jung, Joon Sung Kim, Byung-Wook Kim, Sung Min Park, Gi Jun Kim, Seung Ji Ryu, Young Wook Kim, Jeong Seon Ji, Hwang Choi

Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

Correspondence to: Byung-Wook Kim, Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea. Tel: +82-32-280-5052, Fax: +82-32-280-5987, E-mail: gastro@catholic.ac.kr

Received 5 September 2015 Revised 23 November 2015 Accepted 16 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is a widely accepted and well established procedure because of its curative potential and low invasiveness com¬pared with surgery. Perforation is a potential major complication during ESD, and non-surgical treatments such as endoscopic closure with clips are sufficient in most cases. Here, we report a case of perigastric abscess that occurred as a complication of ESD for EGC. The patient improved with administration of antibiotics without surgical intervention.

Keywords: Endoscopic submucosal dissection, Early gastric cancer, Perigastric abscess

References

1. Fujishiro M. Endoscopic submucosal dissection for stomach neoplasms. World J Gastroenterol. 2006; 12:5108–5112.

2. Minami S, Gotoda T, Ono H, Oda I, Hamanaka H. Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video). Gastrointest Endosc. 2006; 63:596–601.

3. Marcos WC, Petrini BG, Xavier RL, Starling RM, Couto JC, Ribeiro GJ. Gastric wall abscess–an uncommon condition treated by an alternative form. Clinics (Sao Paulo). 2010; 65:819–821.

4. Cho SJ, Choi IJ, Kim SJ, et al. Clinical significance of intraperitoneal air on computed tomography scan after endoscopic submucosal dissection in patients with gastric neoplasms. Surg Endosc. 2014; 28:307–313.

5. Fujishiro M, Yahagi N, Kakushima N, et al. Successful non-surgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms. Endoscopy. 2006; 38:1001–1006.

6. Watari J, Tomita T, Toyoshima F, et al. Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study. World J Gastrointest Endosc. 2013; 5:281–287.

7. Jeon SW, Jung MK, Kim SK, et al. Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions. Surg Endosc. 2010; 24:911–916.

8. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47:829–854.

9. Kiil C, Rosenberg J. Gastric intramural abscess successfully drained during gastroscopy. Gastrointest Endosc. 2001; 53:231–232.

10. Choong NW, Levy MJ, Rajan E, Kolars JC. Intramural gastric abscess: case history and review. Gastrointest Endosc. 2003; 58:627–629.

11. Kang BC, Kim KW, Lee SW, Kim JH. Gastric wall abscess: imaging diagnosis and endoscopic treatment. J Comput Assist Tomogr. 1998; 22:673–675.

12. Lee FI, Ong T, Thiarakan J. Perigastric abscess following Nissen fundoplication. Gastrointest Endosc. 1995; 41:620.

13. Mori H, Kobara H, Rafiq K, et al. Effects of gastric irrigation on bacterial counts before endoscopic submucosal dissection: a randomized case control prospective study. PLoS One. 2013; 8:e65377.

14. Ikehara H, Gotoda T, Ono H, Oda I, Saito D. Gastric perforation during endoscopic resection for gastric carcinoma and the risk of peritoneal dissemination. Br J Surg. 2007; 94:992–995.

Fig. 1.

Procedure of endoscopic submucosal dissection for the lesion. (A) A slightly depressed intramural hemorrhagic lesion is noted at the lesser curvature side of the distal corpus. (B) After spraying indigo carmine, marking was done with argon plasma laser.(C) Precut with hook knife was performed. (D) Dissection of the submucosal layer was performed.

Fig. 2.

(A) Chest radiograph immediately after endoscopic submucosal dissection. Intraperitoneal free air is noted on the right subdiaphragmatic area (arrow). (B) Chest radiograph 4 days after Endoscopic submucosal dissection. The amount of intraperitoneal free air markedly decreased (arrow).

Fig. 3.

Initial abdominal computed tomography. It reveals loculated fluid collection at the perigastric area of fundus (arrow).

Fig. 4.

Abdominal computed tomography after 5 weeks. It shows resolution of the previous perigastric fluid collection (arrow).

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