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Abstract
Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-in-duced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping.
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Fig. 2.
Colonoscopic findings. (A) Penetrated 8.5 Fr catheter is noted at mid-ascending colon. (B) Hemoclipping was done at the penetrating site. (C) Catheter was then withdrawn and the openings were closed by applying 6 hemoclips.
Fig. 3.
Colonoscopy and fluoroscopy findings. (A) Dye leakage is not observed on the fluoroscopic image obtained on 12th hospital day. (B) Dye leakage is still absent on the fluoroscopic image obtained on 30th hospital day. (C) Colonoscopic view also demonstrates healed perforation without evidence of leakage.
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