PERFORATION OF THE STOMACH FOLLOWING ENDOSCOPIC INJECTION HEMOSTASIS : CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

A 71-year-old man was admitted to our hospital with hematemesis. He was in shock state on arrival and endoscopy was carried out immediately after stabilization of vital signs with transfusion. Spouting bleeding from an exposed vessel of gastric ulcer on the angulus was seen and endoscopic injection therapy with hypertonic saline .epinephrine solution (HS-E) around the vessel and pure ethanol aside the vessel was carried out. On the next day, endoscopic study revealed a large ulcer developed on anterior wall of the stomach united with the ulcer on the angulus. Diffuse peritonitis appeared on the day 6th and a distal gastrectomy was carried out on the day 7th. The injection induced ulcer with perforation was located on the anterior wall of the stomach but the ulcer of angulus was not perforated. Pathologically, the injection induced ulcer had been developed along one of the anterior parietal branch of the left gastric artery. The arterial wall of the parietal branch was severely degenerated transmurally and thrombi were seen intraluminally. The proper muscle of the stomach along the parietal branch was also severly degenerated which was similar to the muscular change with myocardial infarction. These findings suggest that the perforation of the stomach was caused by ischemia with thrombosis that was the result of injection therapy.