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Endoscopic treatment for peptic ulcer perforation

Dušan Polák MUDr.

Gastroenterological center University Hospital with Polyclinic in Žilina

Background

Perforation of an acute ulcer is a serious and life-threatening condition. Treatment for this sudden abdominal event is surgical in the majority of cases.

Case report

An 81-year-old woman with coronary heart disease was admitted to our department due to severe anemia and melena. After she had been stabilized, upper gastrointestinal endoscopy revealed an ulcer at the duodenal bulb, with an adherent clot (Fig. 1). It was decided to remove the clot using a water jet. After it had been removed, however, a developing perforation was observed. It was immediately decided to close the perforation using an over-the-scope clip (OTSC) (Figs. 2, 3). The perforation was also plugged with greater omentum. After closure, the results were checked by a surgeon. Contrast radiography did not show any extraluminal leakage (Fig. 4).

Conclusion

Acute upper gastrointestinal bleeding from ulcers is a common finding in clinical practice. Perforation of the ulcer is an undesirable potential complication during therapy. This case shows that using an OTSC clip appears to be an effective potential solution for this type of complication. Involvement of a surgeon in the procedure is extremely important.

Fig. 1 The ulceration before closure.
Fig. 2 Closure of the perforation.
Fig. 3 X-ray image of the over-the-scope clip.
Fig. 4 Contrast radiograph, showing no leakage from the perforation site.

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