An 82-year-old woman was admitted for syncope and fertigation.
The patient was operated 20 years ago for hiatal hernia that recurred and underwent hysterectomy.
Normal tumor markers.
Gastroscopy: hiatal hernia.
Colonoscopy under deep sedation with propofol and CO2 fixation: good cleaning of colonic segment explored.
After progressing with difficulty about 25 cm through a fixed sigmoid, an iatrogenic perforation occurs, which is suspected at the time of being performed, so the anal margin is removed, appraising an 18 cm orifice.
Given the clinical stability of the patient, it was decided to attempt endoscopic treatment by closing the perforation with placement of an Ovesco® overclip.
In order to do so, after removing the illustrative colon, we insert into the distal end of a therapeutic gastrocnempus border 1Olympus GIF 160, the plastic cap on which an open polyp is mounted 11
After reaching the epipluch of the colon perforation, we approached the end of the lumen by aspiration, without requiring traction of the tissue with any forceps.
We then proceeded to release the clip, which, when loosened from the cap, closed off the cap and closed it close to the edges of the perforation, which also embraced the fragment of omentum aspirated patch.
The closure of a minimal superficial residual recess was completed with the placement of two endoscopic clips (Boston Scientific®).
Finally, a careful exploration of the area was carried out with a 4.9 mm gastrompus (Olympus GIF N 180) verifying the apparent presence and the existence of proximal crossings.
The patient was transferred to the Surgery Department for monitoring, with prior knowledge of the case by the nursery surgeon who agreed with the endoscopic approach.
He had normal vital signs and mild abdominal pain without developing peritonitis, with treatment with absolute diet, serum therapy, analgesics and broad-spectrum antibiotics.
Twenty-four hours later, an abdominal CT scan showed metal artifacts in the sigmoid colon, compatible with the clips used for sealing the perforation, and superior perihepatic gas bubbles and hemiab.
A second CT scan performed five days later showed a small collection of 2.5 x 2 cm adjacent to the sigmoid colon, without pneumoperitoneum, which subsequently remained unchanged.
Digestive tolerance was initiated 48 hours later and the patient was discharged on the 10 day after the perforation.
Seven months later, the patient remains asymptomatic with persistence of the metallic clip in the sigmoid colon, which was confirmed by abdominal CT, which showed no complications.
The patient did not want to undergo other examinations because she was asymptomatic and had no increase in fertigation.
