Endoscopic observation of the healing process in a conservative treatment case with a perforation of the transverse colon

The patient was a 72-year-old woman. She was referred to our department with the findings of subphrenic free air. There was subcostal tenderness without peritoneal irritation sign. We suspected of an upper gastrointestinal perforation. We selected conservative therapy taking into consideration the antithrombotic therapy for her comorbidities such as old myocardial infarction. We were able to discharge her in the treatment of 2 months although she had been complicated by liver abscess that required drainage. We were not able to detect any perforation in the upper gastrointestinal tract during the hospitalization. Colonoscopy performed after discharge revealed a hill-shaped protrusion of 5 mm diameter with oozing and fold convergency in the mid-transverse colon. Colonoscopy after 8 weeks showed flattened healing tendency of the lesion, and histopathological findings of its biopsy was mere healing process of a common inflammatory lesion. We managed a case of gastrointestinal perforation healing conservatively; it turned out to be idiopathic perforation of the transverse colon. We reported the course of endoscopic images that are estimated as the healing process of a colonic perforation usually difficult to observe.