Sigmoid perforation after endoscopic clip placement in an infant: A case report

Intestinal perforation following endoscopic clip placement is an uncommon complication that has been reported in adult patients but, as far as we now, not in pediatric patients. An 8-month-old female infant with a history of metabolic encephalopathy was admitted with a convulsive disorder requiring mechanical ventilation. On the seventh day of hospitalization in the intensive care unit, the patient experienced three bowel movements with dark blood clots. Despite being hemodynamically stable upon physical examination, her hemoglobin level decreased to 8.6 g/dL. Upper endoscopy findings were normal, and exploratory laparoscopy ruled out Meckel's diverticulum or other visible parietal causes of bleeding. Lower gastrointestinal endoscopy revealed ulcers in the rectum, sigmoid, and terminal ileum, where hemostatic clips were placed. No repeated bleeding events occurred. However, 20 days later she presented with fever, abdominal pain, and distension. Abdominal radiography revealed pneumoperitoneum, leading to an emergency exploratory laparotomy. A perforation of the sigmoid colon from one of the clips was found. We resected the short segment of sigmoid colon that contained the perforation and did an end-to-end anastomosis. She recovered well and had no complications. Hemostatic clips placed endoscopically in the colon can lead to perforation even several weeks after placement.