내시경 밴드 결찰술로 치료한 대장천공 1예
A Case of a Successful Band Ligation of a Colonic Perforation during Diagnostic Colonoscopy
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초록
대장내시경은 비교적 안전한 검사이나 드물게 발생하는 대장천공이 문제가 될 수 있다. 대장천공의 치료에 있어서 고전적인 방법인 수술 대신 내시경 클립술을 이용한 보존적인 치료에 대한 연구가 이어지고 있으나 클립의 구조적인 한계 및 내시경과 천공부위가 이루는 각도로 인해 클립술이 어려운 경우가 있다. 저자들은 내시경과 천공부위가 평행하여 클립술이 어려웠던 구불결장 천공 환자에서 밴드 결찰술을 시행하여 봉합에 성공하였으며 이를 문헌고찰과 함께 보고한다.
Abstract
Colonoscopy is a relatively safe tool for diagnosis and treatment of colorectal disease. But colonic perforation during colonoscopy is a severe complication and sometimes becomes a life-threatening condition. It occurs with a frequency of 0.07% among patients having diagnostic colonoscopy and in up to 0.40% of patients having therapeutic colonoscopy. In these cases, surgical treatment is needed but endoscopic repair and conservative management could reduce the need for immediate operations. Endoscopic clipping has been the principal method for non-operative treatment of iatrogenic colonic perforation, but it has important limitations. One of them is that it is technically difficult to clip when the angle of approach is tangential. Here we report a case of an iatrogenic colonic perforation treated with endoscopic band ligation rather than endoscopic clipping, because of approach difficulties.
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