Laparoscopic endoloop technique - A novel approach of managing iatrogenic caecal perforation and literature review

N Merali; A Hussain

doi:10.1016/j.ijscr.2015.02.036

Laparoscopic endoloop technique - A novel approach of managing iatrogenic caecal perforation and literature review

Int J Surg Case Rep. 2015:9:31-3. doi: 10.1016/j.ijscr.2015.02.036. Epub 2015 Feb 20.

Authors

N Merali¹, A Hussain²

Affiliations

¹ Minimal Access Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, BR6 8ND London, UK. Electronic address: nabeel.merali@nhs.net.
² Minimal access unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Honorary Senior Lecturer at King's College Medical School, Orpington, BR6 8ND London, UK.

Abstract

Introduction: An iatrogenic caecal perforation is rare, but a serious complication associated with significant morbidity and mortality. We present a 4min and 50s video on a new improvisation undertaken during laparoscopic management of post-polypectomy caecal perforation.

Presentation of case: Our patient presented with an acute abdomen following endoscopic polypectomy. At surgery, the site of caecal perforation was close to the appendicular base with devitalization tissue, secondary to diathermy usage. The hallmark of safety within this novel technique included fresh healthy tissue margins within the endoloop (detachable snare ligation) and ensuring no ischemic tissue was gathered. Complete freeing of the appendix and meso-appendicular base was required and securing three endoloops proximal to the site of perforation. The post-operative course was uneventful.

Discussion: The World Society of Emergency Surgery (WSES) 2013 guidelines suggested an early laparoscopic approach is a safe and effective treatment for colonoscopy-related colonic perforation. There are no national guidelines and the management is dictated by the clinical condition of the patient, co-morbidity, size and site of perforation as well as the scale of bowel preparation, and surgical experience.

Conclusion: The endoloop technique described, undertaken during a laparoscopy is a novel approach. It is a simple and effective method, reminding clinicians to adapt techniques when necessary. Nevertheless, it is only limited to perforations around the appendicular base.

Keywords: Caecal; Colonoscopy; General surgery; Laparoscopic surgery; Perforation; Polypectomy.