Korean J Gastroenterol.  2020 Aug;76(2):83-87. 10.4166/kjg.2020.76.2.83.

Pneumothorax Following Gastric Endoscopic Mucosal Resection

• Koh M
• Jang JS
• Cha JH

• KMID: 2505870
• DOI: http://doi.org/10.4166/kjg.2020.76.2.83

Abstract

An endoscopic mucosal resection (EMR) is used widely as an alternative treatment to a surgical resection for early gastric neoplasticlesions. Among the unusual complications of gastric EMR, perforation is usually manifested as a pneumoperitoneum. Thispaper reports a patient with a left-side pneumothorax without pneumoperitoneum as a complication of gastric EMR. The patientdeveloped a left side pneumothorax after gastric EMR in the gastric fundus and recovered without further complications afterconservative treatment, including endoscopic clipping.

Keyword

Endoscopic mucosal resection; Complication; Perforation; Pneumothorax

Figure

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  Fig. 1 Endoscopic finding of the patient before the procedure. The lesion (tubular adenoma, type IIa+IIc, 10×10 mm in diameter) was located at the fundus of the stomach.

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  Fig. 2 Endoscopic findings of the patient during the procedure. (A) After confirming the lesion boundary, marking was performed using an endoscopic dual knife. (B) After the endoscope equipped with the endoscopic band ligation equipment was inserted to allow the entire lesion to fit inside the rubber band, the lesion was completely ligated into the band after inhalation. (C) Resection was performed using a snare.

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  Fig. 3 Endoscopic findings of the patient after the procedure. (A) No definite perforating hole was seen immediately after the endoscopic mucosal resection, but a deep muscular site was exposed, and there was bleeding from vascular exposure. (B) Endoscopic clipping was performed at the suspicious micro-perforated site.

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  Fig. 4 Plain chest and abdominal radiographs. (A) Plain chest radiography performed immediately after the endoscopic mucosal resection (EMR). This panel shows the left-sided pneumothorax and no free air at both sub-diaphragm. (B) Plain abdominal radiography performed immediately after the EMR. This panel shows no gas within the peritoneal space. (C) Plain chest radiography taken the day after EMR. This photograph shows an improved pneumothorax without a chest tube.

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  Fig. 5 Follow-up endoscopy findings. (A) The micro-perforated site had completely healed with a scar and two hemo-clips two months later. (B) After six months, the post- endoscopic mucosal resection site area had completely healed with scars.

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