A rare case of delayed duodenal perforation due to an over-the-scope clip

A 53-year-old man was referred to our department because of jaundice. We performed endoscopic retrograde cholangiopancreatography, which revealed an ampullary carcinoma. Endoscopic biliary and pancreatic stenting were performed ([Fig. 1]); however, 3 days later, the patient developed a fever and abdominal pain. Computed tomography (CT) revealed a duodenal perforation due to stent deviation ([Fig. 2]). Esophagogastroduodenoscopy confirmed the duodenal perforation opposite the papilla that had been caused by a pancreatic stent. We deployed an over-the-scope (OTS) clip (Ovesco Endoscopy AG, Tübingen, Germany) for closure of the perforated site ([Fig. 3]; [Video 1]). Subsequently, we performed percutaneous drainage for a retroperitoneal abscess that formed, extending from the site of the perforation to the pelvis. The retroperitoneal abscess did not improve, even after 3 weeks of drainage. Contrast imaging of the percutaneous drainage tube revealed leakage from the side of the OTS clip deployment site ([Fig. 4]). We diagnosed the patient as having a delayed perforation due to the OTS clip and performed pancreaticoduodenectomy. Histopathological findings showed perforation of all layers in the area of the OTS clip ([Fig. 5]).