인문학
사회과학
자연과학
공학
의약학
농수해양학
예술체육학
복합학
DBpia AI
AI 에이전트
AI 아이디어
AI 리더
AI 뷰어
Citeasy
크롬 서지관리 다운로드
지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록·키워드
A 52-year-old man presented with recurrent small-bowel bleeding. Capsule endoscopy showed a few proximal–mid ileal erosions. Magnetic resonance enterography was unremarkable. The patient’s body mass index was 24.6 kg/m2, and he had no history of surgery. He underwent motorized spiral enteroscopy from the antegrade route. Enteroscopy up to the mid–distal ileum was normal, beyond which there was nonprogression. Total enteroscopy was attempted with manual abdominal pressure and position changes but was not successful after considerable attempt and time (nearly 30 minutes). Although there was further progression of the tip of the scope, there was no progression of the part of enteroscope where the spiral overtube is attached on fluoroscopy. On withdrawal of the scope after putting clips at the depth of maximal insertion (Fig. 1A), there was moderate resistance that was overcome by forward and backward rotation of the overtube with sudden loss of resistance. On further withdrawal, the peritoneal cavity was entered, and the liver was seen (Fig. 1B). On withdrawal out of the peritoneum, a transected end of the bowel was encountered (Fig. 1C). On urgent laparotomy, there was complete transection of the bowel at the mid ileum (Fig. 1D), which was resected and side-to-side anastomosis performed. Intra-operative enteroscopy revealed a distal ileal vascular malformation, which was also resected. On withdrawal of the enteroscope, part of the transected bowel adhered to the proximal part of the overtube where the covering was partially dislodged (Fig. 1E). The patient recovered well after laparotomy and had no further episodes of bleeding at 6 months’ follow-up. A recent systematic review has suggested that the pooled rate of adverse events with motorized spiral enteroscopy is 17% and that they are mainly minor.1Papaefthymiou A. Ramai D. Maida M. et al.Performance and safety of motorized spiral enteroscopy: a systematic review and meta-analysis.Gastrointest Endosc. 2023; 97: 849-858.e5Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar The rate of serious adverse events was only 1%; this included perforation, deep intramural defects, pancreatitis, and significant bleeding requiring transfusion/re-intervention. Gastroesophageal intussusception has been reported with peroral manual spiral enteroscopy with large hiatal hernia as predisposing factor. We speculate that similar intussusception at the segment of the spiral overtube attachment portion led to complete transection of the bowel while attempting withdrawal.2Chaze I. Gincul R. Lepilliez V. Ponchon T. Saurin J.-C. Gastroesophageal intussusception and multivisceral failure after per oral spiral enteroscopy.Video J Encycl GI Endosc. 2013; 1: 230-232Abstract Full Text Full Text PDF Scopus (3) Google Scholar This led to the detachment of the covering of the overtube and displacement of fins from the underlying scaffold (Fig. 1F). This case highlights the unique adverse event of motorized spiral enteroscopy. Hence, in cases of nonprogression at a given part of the bowel even after change in position and manual abdominal pressure, the scope should be quickly withdrawn without persistent attempt, and enteroscopy should be done from the opposite route if the desired lesion is not reached. All authors disclosed no financial relationships.
인공지능 문자 인식 모델을 통해 추출된 텍스트로, 일부 오타나 오류가 포함될 수 있으나 지속적으로 개선 중입니다.
오류를 발견하셨다면 해당 부분을 드래그한 후 ' 를 통해 신고해주세요.
오류를 발견하셨다면 해당 부분을 드래그한 후 ' 를 통해 신고해주세요.
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