Abstract
A 60-year-old man was admitted to the hospital for endoscopic submucosal dissection (ESD) for early gastric cancer. An intraoperative perforation occurred during the submucosal dissection using an IT knife 2 to resect the gastric lesion located on the posterior wall of the cardia. The perforation site was closed with clips, and the treatment was continued. About two hours after perforation, during treatment, the electrocardiogram showed marked ST depression with negative T wave in leads of II, III, aVF, V1∼V6. We performed an emergency cardioangiography under the suspicion of acute myocardial infarction. No significant stenosis in the coronary artery was revealed, but a left ventriculography showed left ventricular motion abnormality with hypokinesis of the base and hyperkinesis of the apex. We, therefore, diagnosed inverted Tako-tsubo cardiomyopathy. In this case, we thought that this type of cardiomyopathy was caused by the excessive invasive stress such as a pneumoperitoneum following perforation and the prolonged treatment. It is necessary to take this entity into consideration as a potential complication when performing ESD.
