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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2004 December;17(6):231-4
Conservative management of a case of gastric perforation following endoscopic hemostasis. A survey of the literature
Dicasillati R., Villani F., Calati A. M.
We report the case of an asymptomatic and healthy 34-year-old man, who showed pneumoperitoneum after urgent endoscopy performed for an active gastrointestinal bleeding. We considered the patient's condition and decided on a conservative approach to the stomach perforation and to keep close observation. On day 8 postoperatively, since the patient's condition was stable, the tenderness in the epigastrium absent and the alvus normal, he was discharged. In our case, there are 2 interesting features, the iatrogenic etiology of the perforation and the healthy condition of the patient. Instead of a large wall rupture, slough or massive necrosis, no clinical signs of free spillage into the peritoneum were found and free air might be explained as a consequence of endoscopic air dissection of a damaged and aggressively treated stomach wall. In addition, whereas old age and unhealthy conditions are described in similar reports, our patient was young and in a good general status. In such cases, pharmacological therapy, support care and continuous, close observation may be an efficient, non-invasive and safe alternative to surgery. The role of conservative management of pneumoperitoneum is being overviewed and discussed: we propose some decisional criteria for the conservative management of pneumoperitoneum following endoscopy and for the management of a young, healthy patient with pneumoperitoneum due to endoscopy.