A Case of Pneumorrhachis and Pneumoscrotum Following Colon Endoscopic Submucosal Dissection

A 61-year-old man was referred to the hospital for treatment of a laterally spreading tumor (LST) 4 cm in diameter, which was located in the sigmoid colon 24 cm from the anal verge (Fig. 1). It was decided to treat the tumor using ESD without preprocedural histologic diagnosis because the tumor was granular-type suspicious of adenoma or adenocarcinoma confined to the mucosa. ESD was performed using gastroscope (GIF-Q260; Olympus, Tokyo, Japan) with room air insufflation. Following elevation of the submucosal layer by injection of a sodium hyaluronate acid and saline mixed solution (Fig. 2A), circumferential incision and submucosal dissection were performed, using a flex knife and IT-II knife (Olympus). The tissue was dissected along the submucosal layer after incising approximately one-third of the lesion. Thirty minutes after initiating the procedure, a small perforation occurred during dissection using a flex knife (Fig. 2B). During the 10 minutes following perforation, dissection of the surrounding area was done before endoclipping because the clips could A Case of Pneumorrhachis and Pneumoscrotum Following Colon Endoscopic Submucosal Dissection