Bowel obstruction associated with endoscopic tattooing of the colon with India ink

Abstract

During a laparoscopic resection of small colorectal lesions, preoperative endoscopic marking with India ink is useful for identifying the location of the lesion. India ink has been thought to be a safe agent with few adverse effects. We herein report a case who suffered from postoperative abdominal pain resulting in bowel obstruction, due to massive adhesion around the area with India ink. A 61-year-old man with early transverse colon cancer underwent a laparoscopy-assisted transverse colon resection. Prior to the operation, endoscopic tattooing with India ink was performed. At the operation, spillage of India ink into the peritoneal cavity was observed. Many small black spots were thereafter seen on the peritoneum, mesentery and omentum, but neither severe inflammation nor any adhesion was noticed. The operation was performed without any difficulty. Though his immediate postoperative course was uneventful, a bowel obstruction gradually developed from a week postoperatively. Finally, he had to undergo a re-operation, and was found to have diffuse and massive adhesion around areas with India ink. Especially, severe omental adhesion involved and squeezed the transverse colon. A resection of the omentum with stenotic colon and re-anastomosis was performed. India ink can cause severe inflammation and adhesion when it accidentally leaks into the peritoneal cavity.