Endoscopic Submucosal Excavation of Submucosal Foreign Bodies in the Sigmoid Colon

Excerpt

A 52-year-old man was admitted to our hospital due to hypogastralgia and diarrhea for 6 months. Enteroscopy revealed submucosal lesions, which were diagnosed as a possible stromal tumor. Endoscopic ultrasonography showed a gentle slope with a size of approximately 1.5 cm × 0.8 cm seen at the sigmoid colon. The submucosa and muscularis propria could be seen with strip-shaped, extremely high-echo structures (Fig. 1). The whole-abdomen contrast-enhanced computed tomography (CT) examination showed that there were strip-like dense shadows in the appendix area and the posterior wall area of the sigmoid colon (Fig. 2). After carefully inquiring about the patient’s past medical history, we found that he had undergone emergency laparoscopic appendectomy at a local hospital more than 2 years ago. It was found that the center of the lesion could not be protruded when we injected a mixture of 1:10,000 adrenaline with indigo rouge into the submucosa, and it was difficult to cut along the lesion with a dual knife. The mucosa on the surface of the lesion was then removed with biopsy forceps, and the submucosa was exposed. Two milky white hemostatic clips were visible. We then used an IT knife to separate the hemostatic clips layer by layer and clamp them with a mouse clamp, and finally removed them smoothly (Fig. 3).

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