Rare complication of endoscopic band ligation for colonic diverticular bleeding

Abstract

A 79‐year‐old female patient receiving maintenance hemodialysis was referred to our hospital because of massive hematochezia. Abdominal enhanced computed tomography (CT) demonstrated extravasation of contrast medium in the descending colon. We then performed urgent colonoscopy, and successful endoscopic hemostasis was achieved using endoscopic band ligation (EBL) for a bleeding colonic diverticulum. However, the patient unexpectedly complained of severe abdominal pain and fever 5 days after EBL, and abdominal CT revealed free air and mesenteric panniculitis. Emergency surgery was performed, and delayed colonic perforation at the EBL site was confirmed. Although rare, delayed perforation after EBL for colonic diverticular bleeding should be considered.

Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: Systematic review and meta‐analysis

“…22,25 Although no perforation cases were identified in our meta-analysis, four cases have been reported to need surgery for EBL-relevant perforation in a patient with chronic use of corticosteroids, 38 one with a history of abdominal surgery and use of limaprost alfadex, 39 and one who had received hemodialysis. 40 Because of the publication bias in reporting complications, a large number of multicenter observational studies are needed to determine the precise incidence of both treatments.…”

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“…to form on the intestinal mucosa, which assists in the invasion of gut commensal bacteria and may lead to local colonic inflammation. In relation to endoscopy treatment-related perforation, we should consider the potential risk of delayed perforation following hemostasis with the ligation method because of the absence of the muscular layer in the colonic diverticulum [26][27][28]. The incidence of colonic perforation is generally estimated to be 0 %-0.33 % for whole therapeutic colonoscopies (n = 74 630) [29], suggesting that our result of 0.12 % in CDH treatment is not so high compared with other endoscopic treatments.…”

Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study

“…Mechanical tissue damage following an endoscopic procedure causes an ulcer to form on the intestinal mucosa, which assists in the invasion of gut commensal bacteria and may lead to local colonic inflammation. In relation to endoscopy treatment-related perforation, we should consider the potential risk of delayed perforation following hemostasis with the ligation method because of the absence of the muscular layer in the colonic diverticulum 26 27 28 . The incidence of colonic perforation is generally estimated to be 0 %–0.33 % for whole therapeutic colonoscopies (n = 74 630) 29 , suggesting that our result of 0.12 % in CDH treatment is not so high compared with other endoscopic treatments.…”

“…Mechanical tissue damage following an endoscopic procedure causes an ulcer to form on the intestinal mucosa, which assists in the invasion of gut commensal bacteria and may lead to local colonic inflammation. In relation to endoscopy treatment-related perforation, we should consider the potential risk of delayed perforation following hemostasis with the ligation method because of the absence of muscular layer in the colonic diverticulum [26][27][28].…”