Acute intestinal obstruction caused by endoscopic submucosal dissection: A case report.

Background: Endoscopic submucosal dissection (ESD) is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine. However, with the widespread adoption of this technique, the incidence of complications is expected to increase. The most common complications of ESD are hemorrhage and perforation. Rare cases of obstruction after colorectal ESD have been reported, which are often easily misdiagnosed. Therefore, clinicians should maintain heightened awareness of this complication.

Case summary: We report the case of a 50-year-old male who developed bowel obstruction following ESD. On the second day after the procedure, the patient presented with fever and a mild left lower abdominal pain. Physical examination revealed tenderness and rebound tenderness in the left lower quadrant. Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel. The patient continued to fast and was treated with intravenous antibiotics. On the third postoperative day, he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid, with no bowel movement for two days after the procedure. A diagnosis of obstruction after ESD was made. Continuous gastrointestinal decompression was initiated on the fourth day, resulting in symptomatic improvement. Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging. The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.

Conclusion: Acute intestinal obstruction after ESD is a rare complication. Delayed diagnosis or misdiagnosis may be life-threatening. Clinicians should be vigilant for this condition following ESD.