1. Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Soft Tissue Emphysema : Complications of ESD in a Patient with LST of Colon
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon St.Mary’s Hospital

2. F/ 56 이O희
P/Ix
admitted for ESD of a LST-NG of the D colon
proven colonoscopically and histopathologically in previous screening colonoscopy .
P/MHx non-specific
laboratory data and chest radiograph WNL

3. Endoscopic Submucosal Dissection

4. dyspnea.
chest, face and neck became swollen
- R/O subcutaneous emphysema

5. Endoscopic snaring and clipping
Pathology report:
tubulo-villous adenoma
moderate to severe atypia
size 3.0*2.5cm
resected margin free from adenoma
safty margin 0.3cm

6. V/S / – 36.6`C
P/Ex abdomen soft & flat
fluid replacement
antibiotics Tx: cefoperazone + metronidazole
O2 5L nasal prong
close observation

7. post-ESD day#1 Urgent surgical intervention was planned
V/S 120/ `C
dyspnea, abdominal pain
P/Ex board-like rigidity +
ABGA %
Urgent surgical intervention was planned

9. post-ESD day#1
laparoscopic segmentectomy of the descending colon was performed.
resection margin :
proximal 7cm
distal 12cm
mesenteric margin 6.5cm

10. post-ESD D#1
POD #4

11. Review

12. When perforation occurs in the retroperitoneal colon,
air may traverse the diaphragm and progress to the medi-astinum and neck via the visceral space.
Currently endoscopic closure is considered as a first line treatment strategy with low morbidity and mortality in pati-ents without peritoneal irritation.1
there was a recent report that successful closure rate of endoscopic clipping was about 70%.2
Surgical intervention, however, should be considered
when the patient’s clinical condition is deteriorated despit-e adequate management.
Endoscopy. 2009;41:
J Gastroenterol Hepatol. 2007;22: