The was discharged after 10 days. Large foreign bodies can be retrieved by endoscopy and in selected cases gastrointestinal perforations secondary to foreign bodies can also be managed by endoscopy being surgery a
second line approach. “
“A 70-year old man with Parkinson’s disease, congestive heart failure, CABG surgery in 2005, hypertension, renal failure and a BMI of 39 presented with abdominal pain and increasing renal dysfunction. A CT scan was performed with normal findings. A gastroscopy was then performed. A junior doctor performed the endoscopy. He found a duodenal ulcer and a duodenal tumour. The patient experienced intense abdominal pain and abdominal distension immediately after the procedure. A senior surgeon was called find protocol to the endoscopic unit. He realised that a perforation had occurred and relieved p38 MAPK inhibitor review the abdominal pressure placing four 16 G needles through the abdominal wall. The patient was taken to the OR. He was treated with a covered duodenal stent that sealed the perforation. He was allowed to drink immediately after the procedure and recovered. The patient was dismissed within one week. The stent was removed endoscopically in conscious sedation after three weeks. A diagnostic laparoscopy was performed. There was old fibrin and foul liquid above the liver indicating a 2-3 days
old perforation. Due to plentiful intra abdominal fat it was impossible to visualise the duodenum. A per-operative gastroscopy was performed and the duodenal ulcer was recognised. The previously described “tumour”
was found to be the liver surface. Air bubbles were seen on the laparoscopic view while insufflating with the gastroscope, verifying a perforation. It was possible to pass the gastroscope outside the duodenum into the subomental area under the liver. The gastroscope was retrieved and passed down the real duodenal lumen. A guide wire was placed into the distal portion this website of the duodenum. A 9 cm partially covered duodenal stent (Hanarostent, M.I Tech, Korea) was placed over the wire, through the scope with the covered portion reaching into the stomach. No air bubbles were seen at laparoscopy, indicating sealing of the perforation. An abdominal drain was placed. We believe that covered metal stents can be used as a treatment alternative for perforated duodenal ulcers, especially in patients with comorbidities. This treatment option has recently been used in several patients at our department with good results. Simultaneous drainage of the abdominal cavity at the site of leakage seems to be crucial in most cases. Stent treatment together with percutaneous drainage may even be a future alternative to surgery in all patients with perforated duodenal ulcers. “
“Postoperative delayed bleeding of submucosal tunnel is a rare complication after peroral endoscopic myotomy (POEM) for esophageal achalasia. However, once it occurs it can be fatal.