Conservative treatment of perforation during endoscopic submucosal dissection of lower rectal tumor by use of an endotracheal tube.

A 76-year-old man was admitted to our department with suspected rectal tumor recurrence 1 year after transanal endoscopic microsurgery (TEM). Given our reservations about further injury to the anus, endoscopic submucosal dissection (ESD) was proposed. A flat protuberance was found in the lower rectum, and the post-TEM scar was observed close to it, approximately 6 cm long. During the procedure, submucosal fibrosis was observed. Loss of the local muscular layer was apparent in the wound (A, star). The lesion was successfully dissected, but attempts to close the wound with hemostatic clips, rubber band–assisted closure, and purse string suture failed. An endotracheal tube was positioned with the assistance of a guidewire, and air was injected into the air balloon to attach it to the rostral end of the wound. The endotracheal tube was used for this lower rectal lesion to promote wound exclusion and drainage of intestinal juice to prevent infection (B, C). The patient underwent routine fasting and antibiotic prophylaxis and reported no clinical symptoms related to low rectal perforation. The endotracheal tube was placed for only 4 days, during which time the patient had normal elimination. The site of muscle injury recovered well after 9 days (D, star). Thus, fasting and drainage by use of an endotracheal tube is effective in patients with perforations that cannot be closed or sutured during ESD of lower rectal tumors.