case_images: PMC9984940_01
case_images: Colonoscopy viewing. a A 50-mm 0-IIa+IIc (laterally spreading tumor, pseudo-depressed nongranular type) lesion in the cecum. b A mucosal cut was performed. c The viewing during submucosal dissection. d Ulcer base after ESD. Hemostatic clipping was performed on pulsatile vessels.
case_images: crg-2022-0017-0001-529480_f1.jpg
case_images: PMC9984940_01_crg-2022-0017-0001-529480_f1.jpg
case_images: F1
case_images: He was found to have a 50-mm 0-IIa+IIc (laterally spreading tumor, pseudo-depressed nongranular type) lesion in the cecum (Fig. 1a). ESD for treatment because the lesion was early-stage cancer and its size made piecemeal endoscopic mucosal resection difficult. ESD was performed with a water-jet colonoscope (PCF-H290T; Olympus Medical Corp, Tokyo, Japan) (Fig. 1b-d).
case_images: Computed tomography and fluoroscopic findings. a Computed tomography revealed the presence of intra-abdominal free air (arrows) on postoperative day (POD) 2. b The colonoscopy under fluoroscopy showed no perforation in the ulcer and no leakage of the contrast medium. c Computed tomography showed no leakage of contrast medium after colonoscopy under fluoroscopy. d Computed tomography showed no leakage of contrast medium on POD 3. e A follow-up CT on POD 13 revealed a 65-mm pelvic abscess (arrow).
case_images: crg-2022-0017-0001-529480_f2.jpg
case_images: PMC9984940_01_crg-2022-0017-0001-529480_f2.jpg
case_images: F2
case_images: C-reactive protein of 4.27 mg/dL. Computed tomography (CT) revealed the presence of intra-abdominal free air (Fig. 2a). The colonoscopy under fluoroscopy showed no perforation in the ulcer and no leakage of the contrast medium (Fig. 2b). CT showed no leakage of contrast medium after colonoscopy under fluoroscopy (Fig. 2c). Abdominal pain did not worsen, and CT showed no leakage of contrast medium on POD 3 (Fig. 2d). Mild abdominal pain remained, and a follow-up CT on POD 13 revealed a 65-mm pelvic abscess (Fig. 2e).
case_images: EUS-guided drainage and a follow-up computed tomography followed by removal of tubes. a EUS showed a 56-mm pelvic abscess. b A 19-gauge needle was inserted into the abscess. c A 7Fr, 6-cm double pigtail stent and nasobiliary drainage catheter were inserted into the abscess. d Follow-up CT on POD 23 revealed the reduction of the abscess (arrow). e Endoscopic view of drainage tubes removed on POD 23.
case_images: crg-2022-0017-0001-529480_f3.jpg
case_images: PMC9984940_01_crg-2022-0017-0001-529480_f3.jpg
case_images: F3
case_images: EUS-guided drainage was performed with a convex-arrayed echoendoscope (GF-UCT260; Olympus Medical Corp, Tokyo, Japan) (Fig. 3a-c). Tokyo, Japan) and a 7Fr nasobiliary drainage catheter (Flexima; Boston Scientific Corp, Marlborough, MA, USA). The follow-up CT on POD 23 revealed the reduction of abscess, and the drainage tubes were removed (Fig. 3d, e).