Endoscopic partial closure followed by adequate drainage for treating delayed perforation caused by duodenal endoscopic submucosal dissection: A case report

RATIONALE: Delayed perforation of duodenal endoscopic submucosal dissection (ESD) was reported to be up to 14.3%. High invasive surgery remains the main treatment for delayed duodenal perforation. PATIENT CONCERNS: A 56-year-old woman presented with abdominal pain and fever at 1st day after ESD for treating a large laterally spreading tumor in the second part of duodenum. DIAGNOSIS: Emergent abdominal computed tomography revealed the presence of duodenal perforation. INTERVENTIONS: Endoscopic purse-string technique was used to partially close the large mucosal defect. Percutaneous endoscopic gastrostomy was conducted for gastric drainage and proximal drainage of the wound. A nasointestinal decompression tube was placed for distal drainage of the wound. OUTCOMES: No further symptoms were noted after 5 days. Both upper gastrointestinal series and endoscopy confirmed the healing of the wound. LESSONS: Partial closure of the mucosal defect followed by adequate drainage can be selected as a preferred choice for management of delayed duodenal perforation. It may also serve as an alternative for prevention of delayed perforation when complete closure of the mucosal defect is technically difficult or impossible.