Endoluminal Closure of Colon Perforation with Endoscopic Band Ligation: Technical Feasibility and Safety in an In Vivo Canine Model

BACKGROUND/AIMS: Endoscopic band ligation (EBL) is an accepted method in the management of variceal bleeding; however, there is little evidence on the safety and feasibility of EBL for the closure of bowel perforation. In this study, we aimed to evaluate the technical feasibility and efficacy of EBL in iatrogenic colon perforation by using a canine model. METHODS: We established an iatrogenic colon perforation model by using seven beagle dogs. Longitudinal 1.5- to 1.7-cm colon perforations were created with a needle knife and an insulated-tip knife, and the perforation was subsequently closed with EBL. During a 2-week follow-up period, the animals were carefully monitored and then euthanized for pathologic examination. RESULTS: The EBL of iatrogenic colon perforations was successful in all dogs. The mean procedure time for EBL closure with one to three bands was 191.7 seconds, and there were no immediate complications. One animal was euthanized after 3 days because of peritonitis. There were no clinical and laboratory features of sepsis or peritonitis in the remaining six animals. On necropsy, we did not find any fecal peritonitis, pericolonic abscess formation, or transmural dehiscence at the perforation site. Histopathology demonstrated inflamed granulation tissue and scar lesions replaced by fibrosis. CONCLUSIONS: EBL might be a feasible and safe method for the management of iatrogenic colon perforations in an in vivo model.

A Bowel Perforation That Developed during the Transanal Extraction of a Large Rectal Foreign Body / 대한소화기내시경학회지

Rectal foreign bodies are rare clinical problem in South Korea. Although many foreign bodies can be extracted safely using endoscopic procedures, some patients require surgery. Here we describe the case of a 35-year-old male who presented with a rectosigmoid foreign body, a large carrot measuring 28x7 cm. Sigmoidoscopy revealed a carrot in the upper rectum extending to the sigmoid colon. Endoscopic removal failed. The surgeon unsuccessfully attempted to extract the carrot using various tools without spinal anesthesia. During the extraction attempt, the patient complained of sudden abdominal pain, and a simple x-ray revealed pneumoperitoneum. An emergency colotomy and removal of the foreign body was performed, followed by primary repair of the perforation and a colostomy. Three months later, the colostomy was repaired.