Post-Polypectomy Electrocoagulation Syndrome

Abstract

Post-polypectomy syndrome, described here, is a well-known but often forgotten complication of colonoscopy. A 52 year old woman with a history of colon polyps presented with acute abdominal pain after undergoing screening colonoscopy earlier that day, with snare cautery resection of a 1.5cm polyp in the right colon, which did not show evidence of perforation. A few hours after the procedure, she developed progressively worsening right lower quadrant abdominal pain associated with nausea, vomiting, one episode of black stool and a presyncopal episode. She was febrile and had a leukocytosis to 18,000. A CT of the abdomen showed marked wall thickening of the cecum and proximal ascending colon, without evidence of bowel obstruction, perforation or appendicitis. Given the evidence of inflammation in the area of polypectomy without evidence of perforation, she was diagnosed with post-poylpectomy electrocoagulation syndrome. She was given IV fluids, antibiotics, without recurrence of black stools and with stable hemoglobin. Her pain improved with conservative treatment and she was discharged home on a short course of antibiotics. Post-polypectomy electrocoagulation syndrome refers to transmural burn of the colon at the site of electrocautery due to electrical current reaching into the muscularis propria and serosa, causing inflammation without perforation. It leads to abdominal pain within 12 hours, fever, leukocytosis, elevated CRP and peritoneal inflammation. It occurs in 1.4-3.7%1 of cases, but hospitalization is usually unnecessary, only in 0.07% of cases2. Risk factors include hypertension, large lesion size, polypoid configuration,2 age, and gender. Underlying disease such as diabetes & chronic liver disease, and use of antithrombotics do not seem to increase risk.2 In one case control study2, major complications are rare at 2.9% but no cases of mortality have been reported. Further studies have reinforced this favorable prognosis.