{
  "abstract": "Colonoscopy is an essential tool for the initial assessment of Inflammatory Bowel Disease in children. Main complications include bleeding, infection and perforation. The literature around complications in Paediatric endoscopy is sparse. The estimated rates of perforation in children are 0.01% to 0.13% for all endoscopies and 1% for interventional procedures. It carries a significant morbidity and mortality.Case Report A 9 year-old boy presented to the Paediatric Gastroenterology clinic with 2 years history of intermittent lower abdominal pain, loose stools with blood and tenesmus. His weight was on 50 —75th centile and height on 25-50th centile. He did not have any features of extraintestinal involvement. There was family history of coeliac disease in Mum and half siblings. There was no history suggestive of Ehler Danlos or Epidermolysis bullosa. There were no risk factors from an anaesthetic point of view identified in clinic. There was no significant past medical history. Physical examination had been unremarkable with a normal soft abdomen with no tenderness or palapable mass. Full Blood Count had shown thrombocytosis (705 x 109/L) and elevated erythrocyte sedimentation rate of 31mm/hr. Other blood tests including Urea and Electrolyte, Liver Function Test, albumin (40g/l), coeliac screen were unremarkable. Faecal calprotectin was elevated at 1422mg/kg The patient underwent a diagnostic UGI Endoscopy and Ileocolonoscopy under general anaesthesia using a flexi laryngeal mask airway. Upper GI endoscopy revealed small polyp less than 0.5 cm at the distal end of the oesophagus, mild nodularity in the antrum and lax gastroesophageal junction. Ileocolonoscopy showed severe patchy colitis worse in the ascending and transverse colon with relatively spared rectum and patchy erythema in the terminal ileum. There were deep seated ulcers with slough and easy friability worse in the caecum. Caecal perforation was noted immediately after caecal biopsy. The patient was subsequently intubated and ventilated. 7 Bostons resolution clips were applied to close the mucosal defect (figure 1) A contrast study was performed after the clips were applied (on table) which confirmed bowel continuity and no evidence of pneumoperitoneum. Post operatively, he was kept nil by mouth and started on Total Parenteral Nutrition . On day 6 post procedure, CT abdomen and pelvis with contrast was performed which did not demonstrate any evidence of residual post-operative complications such as leakage, fistula or peritonitis. A presumptive diagnosis of Ulcerative colitis (UC) with backwash ileitis (E4S1) was made. The patient was started on Anti-TNF α treatment (Infliximab 10 mg/kg) on an accelerated regimen 0,1 and 5 weeks . He was discharged on day 10 without any complications. He has been subsequently followed up in clinic and is doing well.Conclusion Iatrogenic perforation during high risk paediatric colonoscopy can be managed using endoscopic clips , even in patients with Ulcerative colitis, thus avoiding the need for surgery.References Thakkar K, El-Serag HB, Gilger M. Complications of pediatric colonoscopy: a five-year multicenter experience. Clin Gastroenterol Hepatol. 2008 May;6(5):515–20.Hsu EK, Chugh P, Mamula P. Incidence of perforation in pediatric GI endoscopy and colonoscopy: an 11-year experience. Gastrointest Endosc. 2013 Jun;77(6):960–6.Abstract OC71 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Sunita Rajani"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Wuthinan Nivatvongs"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Marta Cohen"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Christopher Ng"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Arun Urs"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Mike Thomson"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Schluckebier Dominique"
    },
    {
      "affiliations": [
        "Gastroenterology, Sheffield Children’s Hospital"
      ],
      "name": "Akshay Kapoor"
    }
  ],
  "title": "OC71 Endoscopic resolution clips to repair iatrogenic caecal perforation in acute severe ulcerative colitis",
  "uid": "b606b4a5-8fe4-5664-b6de-5be2a6f8b772"
}