Novel use of endoscopic pigtail drainage in recurrent gastric perforation following intentional drug overdose: a case report.

Peptic ulcer perforation (PUP) is a life-threatening surgical emergency. Persistent perforation after conventional repair is rare, and minimally invasive salvage techniques are infrequently reported. We present a case where endoscopic pigtail catheter drainage offered a novel solution for a persistent leak. A 33-year-old man with substance use history developed generalized peritonitis after an intentional drug overdose. Emergency laparotomy revealed a 7 × 7 mm prepyloric perforation, repaired with a Graham patch. Premature oral intake led to a larger persistent perforation 5 days later, requiring repeat surgical repair. Persistent leakage continued for nearly a month and was successfully managed using an endoscopically placed pigtail catheter without a stent. The patient recovered completely, as confirmed at a 6-week follow-up. Endoscopic pigtail catheter placement is a minimally invasive, organ-preserving salvage therapy for persistent PUP after failed surgical repair. Further studies are needed to establish standardized protocols.