Continuous wound irrigation and drainage for treating large contained duodenal perforation after EMR

A 59-year-old woman experienced a contained duodenal perforation 3 days after undergoing EMR for a 50 × 15 mm duodenal laterally spreading duodenal tumor. Endoscopy confirmed the duodenum contained perforation with abscess and sinus tract formation (A). The patient refused surgery; thus, we decided to treat the condition endoscopically. Because the postoperative wound was large, accounting for about three-quarters of the duodenal lumen, and the wound still showed the presence of infection after flushing, simple closure (including over-the-scope clip closure) would have been challenging and not conducive to wound healing. Thus, continuous wound irrigation and drainage were performed.