Complication Of Colonoscopy Research Articles

Post-Polypectomy Electrocoagulation Syndrome

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.

Air on the Side of Caution: An Uncommon Colonoscopy Complication

Air on the Side of Caution: An Uncommon Colonoscopy Complication

Colonoscopic perforations: Single center experience and review of the literature.

Iatrogenic colonic perforation is a well-known complication that can increase mortality and morbidity in patients undergoing colonoscopy. Closer follow-up and a well-planned treatment strategy are required when perforation arises as a complication. The aims of this study are to (1) report our experience with a large colonoscopy series; (2) evaluate the underlying mechanisms of iatrogenic colonic perforation; (3) discuss the ideal period between onset and treatment; and (4) review the current literature regarding the management of iatrogenic colonic perforations. Patients who underwent colonoscopy between January 2005 and May 2015 at a single center were reviewed retrospectively. Procedures during which colonic perforations occurred were documented and analyzed. Between January 2005 and May 2015, 31,655 patients underwent colonoscopy and 5,214 patients underwent recto-sigmoidoscopy at our center. Thirteen of these procedures were associated with perforation. The perforation rate was found to be 0.041%. The most frequent locations of perforation were (a) the rectosigmoid junction, (b) the proximal rectum, and (c) the sigmoid colon. Management included surgical treatment in 11 patients and conservative management in 2 patients. Twelve patients (92.31%) were discharged uneventfully, and death occurred in one (7.69%) patient. Although they are rarely encountered, colonic perforations are serious complications of colonoscopy. A high index of clinical suspicion is required for early diagnosis and appropriate treatment. Age, co-morbidities, the location and size of the perforation, and the time interval between onset and diagnosis should be evaluated, and the treatment approach should be planned accordingly.

Anesthesia Assistance in Outpatient Colonoscopy and Risk of Aspiration Pneumonia, Bowel Perforation, and Splenic Injury

The increase in use of anesthesia assistance (AA) to achieve deep sedation with propofol during colonoscopy has significantly increased colonoscopy costs without evidence for increased quality and with possible harm. We investigated the effects of AA on colonoscopy complications, specifically bowel perforation, aspiration pneumonia, and splenic injury. In a population-based cohort study using administrative databases, we studied adults in Ontario, Canada undergoing outpatient colonoscopy from 2005 through 2012. Patient, endoscopist, institution, and procedure factors were derived. The primary outcome was bowel perforation, defined using a validated algorithm. Secondary outcomes were splenic injury and aspiration pneumonia. Using a matched propensity score approach, we matched persons who had colonoscopy with AA (1:1) with those who did not. We used logistic regression models under a generalized estimating equations approach to explore the relationship between AA and outcomes. Data from 3,059,045 outpatient colonoscopies were analyzed; 862,817 of these included AA. After propensity matching, a cohort of 793,073 patients who had AA and 793,073 without AA was retained for analysis (51% female; 78% were age 50 years or older). Use of AA did not significantly increase risk of perforation (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.84-1.16) or splenic injury (OR, 1.09; 95% CI, 0.62-1.90]. Use of AA was associated with an increased risk of aspiration pneumonia (OR, 1.63; 95% CI, 1.11-2.37). In a population-based cohort study, AA for outpatient colonoscopy was associated with a significantly increased risk of aspiration pneumonia, but not bowel perforation or splenic injury. Endoscopists should warn patients, especially those with respiratory compromise, of this risk.

Acute appendicitis – a rare complication of colonoscopy

Acute appendicitis – a rare complication of colonoscopy

Assessing the impact of colonoscopy complications on use of colonoscopy among primary care physicians and other connected physicians: an observational study of older Americans

ObjectivesPsychological biases can distort treatment decision-making. The availability heuristic is one such bias, wherein events that are recent, vivid or easily imagined are readily ‘available’ to memory and are therefore...

Complication Rates in Colonoscopy Screening for Cancer.

Screening colonoscopy has been offered in Germany since 2002. Complications during colonoscopy were reported to be rare, but data on potential complications after colonoscopy are sparse. We aimed to comprehensively assess the frequency of complications arising during or within four weeks of screening colonoscopy. Residents of the German federal state of Saarland without a history of colorectal cancer and without previous polypectomy who underwent a screening colonoscopy between 2010 and 2013 were included. A follow-up was conducted three months after the screening colonoscopy, including participant questionnaires and subsequent validation of self-reported complications arising during or within four weeks of screening colonoscopy, by reviewing colonoscopy records and contacting the treating physicians. A comprehensive mortality follow-up was conducted for non-responders. We recruited a total of 5527 participants from 26 practices (median age 61 years, 52% women). 5252 (95%) fully completed the questionnaire on complications and met the inclusion criteria for analysis. Among these participants, 16 cases of physician-confirmed bleeding (0.30%) and four cases of physician-confirmed perforation (0.08%) occurred during or within four weeks of colonoscopy. According to consistent reports from patients and physicians, bleeding and perforation led to hospitalization in 5 (0.095%) and 2 (0.04%) cases, respectively. Three participants died within three months of colo - noscopy. In none of these cases was the cause of death related to colonoscopy. We found the risk of complications of screening colonoscopy to be low, even when taking into account a potential delay of up to four weeks.

Emergency splenectomy postelective colonoscopy

Colonoscopy is the gold standard for investigation of colorectal carcinoma and inflammatory bowel disease. Splenic injury is a rare but potentially fatal complication of colonoscopy. The present case study outlines...

Jatrogeninė kolonoskopinė storosios žarnos perforacija: vieno centro chirurginio gydymo rezultatai

Įvadas Nors kolonoskopinių gaubtinės žarnos perforacijų dažnis nėra didelis, tačiau jos gali lemti sunkias komplikacijas ar net mirtį. Šios studijos tikslas buvo įvertinti kolonoskopinių gaubtinės žarnos perforacijų dažnį ir jų chirurginio gydymo rezultatus.Metodai Retrospektyviai buvo peržiūrėti duomenys pacientų, kuriems atliekant diagnostinę ar gydomąją kolonoskopiją Nacionalinia­me vėžio institute nuo 2007 m. sausio 1 d. iki 2016 m. gruodžio 31 d. įvyko gaubtinės žarnos perforacijos. Analizuoti pacientų demografiniai rodikliai, kolonoskopijos duomenys, informacija apie jų gydymą ir gydymo rezultatus.Rezultatai Iš viso Nacionaliniame vėžio institute minėtu laikotarpiu buvo atlikta 16 186 kolonoskopijos. Bendras kolonoskopinių gaubti­nės žarnos perforacijų dažnis siekė 0,14 % (23 iš 16 186 pacientų). Iš šių 23 perforacijų 20 atvejų buvo taikytas chirurginis gy­dymas. Daugiausiai perforacijų įvyko riestinėje žarnoje (12 atvejų). 11 atvejų defektas žarnoje buvo užsiūtas, 6 atvejais atlikta žarnos rezekcija su pirmine anastomoze. Viena mirtis įvyko dėl ūmios bronchopneumonijos išsivysčius dauginiam organų dis­funkcijos sindromui, kiti du pacientai, kuriems pasireiškė pilvo ertmės sepsis, mirė nuo kardiopulmoninio nepakankamumo.Išvados Jeigu kolonoskopinės gaubtinės žarnos perforacijos atvejais pavyktų išvengti operacijos ir ją lydinčių sunkių komplikacijų, tai leistų reikšmingai sumažinti kolonoskopijos komplikacijos padarinius. Visus pacientus prieš procedūrą būtina įspėti apie galimas komplikacijas, o gydytojai turi būti itin atidūs, jei pacientas priklauso didelės rizikos grupei.

MEDIASTINAL EMPHYSEMA AS A COMPLICATION OF COLONOSCOPY

Cases of mediastinal emphysema (pneumomediastinum), as a complication of endoscopic colonoscopy perforation of the colon, according to the publications and given its own experience in the treatment of this rare complication were analyzed. There are few publications on the perforation of the colon during colonoscopy, with the development of pneumomediastinum, pnevmoretroperitoneuma, pneumothorax in a scientific literature. Air supply into the retroperitoneal space and the mediastinum from perforation of the intestine through the place connected with the lifting him through the natural anatomical connection. Some authors provide proven X-ray of the chest clinical cases pneumomediastinum and subcutaneous emphysema in a patient suspected of having ulcerative colitis after outpatient colonoscopy with biopsies, as well as pneumomediastinum with emphysema of soft tissues of the neck after endoscopic polypectomy. The diagnosis was established clinically (dyspnea, subcutaneous emphysema of the neck), but also the data of X-ray studies. The most life-threatening complication of colonoscopy a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum retropnevmoperitoneuma that requires immediate diagnosis and surgical intervention. In these cases, it may be a tension pneumothorax, in which is shown an emergency thoracostomy. During the stress pneumomediastinum an adequate drainage of the mediastinum and (if indicated) pleural cavities is performed. Clinical terms of self-resolution of mediastinal emphysema account for an average of 6.2 days in the majority of patients. During colonoscopy balloon dilation of strictures of the colon may also be complications: subcutaneous emphysema and bilateral pneumothorax. In our practice, there were two clinical cases of mediastinal emphysema at colonoscopy due to perforation of the sigmoid colon in one case, and perforation of the sigmoid colon diverticulum in another. The patients were operated on with a favorable outcome, laparotomy and bowel resection with anastomosis device SEEA-29 were performed. The perforation of the gut during endoscopy requires emergency surgery. Mediastinal emphysema may be as a complication of colonoscopy and is associated with the air intake from the intestine through the perforation into the retroperitoneal space, and then in the mediastinum. During unstressed pnemomediastinume resorption occurs independent of emphysema in the next day after a bowel injury.

Colonoscopic and histologic features of rectal masses in dogs: 82 cases (1995-2012).

OBJECTIVE To evaluate colonoscopic and histologic features of rectal masses in dogs. DESIGN Retrospective case series. ANIMALS 82 client-owned dogs with rectal masses that underwent colonoscopy. PROCEDURES Medical records of dogs with rectal masses that underwent colonoscopy were reviewed. History, signalment, clinical signs, results of physical examination, diagnostic imaging findings, and results of colonoscopy (including complications) were recorded. When available, tissue samples obtained during colonoscopy and by means of surgical biopsy were reviewed by a single board-certified pathologist. Histologic features and tumor grade (when applicable) of tissue samples obtained during colonoscopy versus surgical biopsy were compared. RESULTS Multiple rectal masses were observed during colonoscopy in 6 of the 82 dogs, but no lesions were visualized orad to the colorectal junction. Results of histologic evaluation of surgical biopsy specimens were consistent with a diagnosis of epithelial neoplasia in 58 of 64 dogs, of which 71% were classified as benign adenoma or polyp and 29% were classified as adenocarcinoma in situ or adenocarcinoma. Complications of colonoscopy occurred in 3 of 82 dogs but were considered minor. A discrepancy in diagnosis occurred in 5 of 16 dogs for which both colonoscopic and surgical biopsy samples were available for histologic review. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that multiple rectal masses are uncommon in dogs, and secondary lesions orad to the colorectal junction were not found in this study. Colonoscopy was associated with few complications, but the need for colonoscopic assessment of the entire colon in this patient population may merit reevaluation.

Web Exclusives. Annals Story Slam - Colonoscopy Complication.

Web Exclusives. Annals Story Slam - Colonoscopy Complication.

Abstract IA14: Decision analysis for colorectal cancer screening recommendations

Abstract IA14: Decision analysis for colorectal cancer screening recommendations

Colonoscopy a Real Diagnostic Paragon

Diagnostic colonoscopy acquires the status of gold standard investigation for evaluation of colonic problems. Formally, colonoscopy was first initiated in June 1969 in America. Colonoscopic history can be traced back to 1958. Matsunaga from Japan was the pioneer as he used a gastrocamera which was the start of colonoscopic era. Flexible sigmoidoscopy was later introduced in 1963. Existing colonic perforation and refusal of a fully compos mentis patient, remain absolute contraindications to diagnostic colonoscopy. Bowel Perforation, although less common, is a disastrous complication of colonoscopy. It is a basic right of any patient who has been offered a colonoscopic procedure to have appropriate, clear and concise information about colonoscopy. Consent literally means permission or an agreement which is granted by a patient to a health care individual to receive examination, test, treatment or intervention. Colonoscopic consent process should be valid and has voluntary, fully informed and capacity aspects as its integral components. There were a lot of oppositions against colonoscopy at that time. It was believed to be dangerous and unnecessary exercise by many surgeons. Time has proved that to be a wrong perception. It is now believed to be an extremely useful diagnostic modality. It is safe procedure in experienced hands and provides valuable clinical information. Colonoscopy is not a pleasant investigation as it is usually related with pain and discomfort by patients; fortunately, good analgesia and safe conscious sedation make this hostile but worthwhile procedure tolerable to patients.Today colonoscopy has kept its status of the gold standard investigation in diagnosing bowel cancer and has prime role in the assessment of majority of large bowel symptoms. Colonoscopy also retains the status of being an investigation with highest sensitivity and specificity, out of all available diagnostic modalities, for identifying adenomatous polyps and now it has acquired a unique status of being a diagnostic paragon.

Pneumothorax, Pneumomediastinum and Pneumoperitoneum in a 10-Year-Old Girl Following Colonoscopy

Colonic perforation is an uncommon but severe complication of colonoscopy. We present a case of a 10 -year-old girl who was treated conservatively for inflammatory bowel disease for 6 years. She underwent a diagnostic colonoscopy after which she developed acute respiratory failure. Urgent bedside imaging series revealed pneumothorax, pneumomediastinum and pneumoperitoneum. A chest tube was immediately inserted, and then she was intubated and ventilated. Laparotomy revealed a 1 cm wide perforation of the transverse colon. The rupture was closed and a terminal ileostomy was performed. The postoperative course was uneventful. To best of our knowledge no other case of pneumothorax, pneumomediastinum and pneumoperitoneum after colonoscopy in children has been reported so far in literature.

How to avoid and treat endoscopic complications

Colonoscopy is a common procedure performed for screening, diagnostic, or therapeutic indications; nevertheless, it is an invasive procedure that has associated risks. Complications of colonoscopy can be divided into four main categories: (1) bleeding, (2) postpolypectomy syndrome, (3) perforation, and (4) rarely, solid organ injury. In this review, we discuss strategies to avoid and treat complications of colonoscopy. Diligent biopsy and use of electrocautery and avoiding looping and blind advancement of the colonoscope minimize the risk of these complications. Management of complications ranges from non-operative conservative management, to minimally invasive endoscopic or laparoscopic techniques, to operative exploration.

A (Not So) Rare Complication of Colonoscopy

Question: A 65-year, old, healthy woman underwent gastroscopy and colonoscopy because of altered bowel habits and mild epigastric pain. The previous medical history was unremarkable except for a complicated hysterectomy a few years ago. The gastroscopy was uneventful; biopsies were taken from the stomach and the duodenum. Owing to looping of the instrument, the colonoscopy was moderately difficult and external pressure to straighten the instrument was needed. Nevertheless, complete colonoscopy with intubation of the terminal ileum was achieved. During the examination, 2 small polyps in the transverse colon and the sigmoid were removed by polypectomy. Four days after the examination, the patient presented in the emergency room with left upper quadrant pain that started approximately 12 hours after the endoscopic examination and was increasing in intensity. Blood pressure and heart rate were unremarkable, the abdomen showed no peritoneal signs but a pain on palpation in the left upper quadrant. A computed tomography scan (Figure A) of the abdomen was done. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The computed tomography scan of the abdomen showed splenic injury with concomitant hematoma. Because the patient was clinically stable, she was managed conservatively without splenectomy and discharged from the hospital after 5 days. Splenic rupture is a rare complication of colonoscopy with a reported incidence of around 0.004%.1Holubar S. Dwivedi A. Eisdorfer J. et al.Splenic rupture: an unusual complication of colonoscopy.Am Surg. 2007; 73: 393-396PubMed Google Scholar Three mechanisms might be responsible for splenic trauma during colonoscopy: direct trauma by passage of the endoscope through the splenic flexure, traction on the splenocolic ligament, and traction on adhesions between the colon and the spleen leading to rupture of the splenic capsule.2de Vries J. Ronnen H.R. Oomen A.P. et al.Splenic rupture following colonoscopy, a rare complication.Neth J Med. 2009; 67: 230-233PubMed Google Scholar A review of 66 patients with splenic injury after colonoscopy3Ha J.F. Minchin D. Splenic injury in colonoscopy: a review.Int J Surg. 2009; 7: 424-427Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar summarized potential risk factors and categorized them as either patient or operator dependent. Patient-dependent factors are splenomegaly, adhesions to the colon from prior surgery, inflammation, and anticoagulation. Operator-dependent factors are inexperience, biopsy or polypectomy in the splenic flexure, excess traction, external pressure, straightening of the instrument, and technically difficult colonoscopy. Several of these risk factors were present in our patient: prior abdominal surgery, technically difficult examination as well as external pressure to straighten the instrument. Because splenic rupture as a complication of colonoscopy is a rare event, a high index of suspicion is necessary for diagnosis. The diagnosis is best made by ultrasound and/or computed tomography scan of the abdomen. In patients who have active bleeding and a low perioperative risk, splenectomy is the treatment of choice but carries the risk of the overwhelming postsplenectomy infection. In patients with active bleeding, hemodynamic instability, active bleeding, and a high perioperative risk, selective embolization of the splenic artery is an option.2de Vries J. Ronnen H.R. Oomen A.P. et al.Splenic rupture following colonoscopy, a rare complication.Neth J Med. 2009; 67: 230-233PubMed Google Scholar Patients with subcapsular hemorrhage only, intact splenic hilum, no hemoperitoneum and hemodynamic stability could be managed conservatively,3Ha J.F. Minchin D. Splenic injury in colonoscopy: a review.Int J Surg. 2009; 7: 424-427Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar In carefully selected patients, failure of conservative treatment is as low as 10%. Endoscopists have to be aware of this complication and take preventive measures in difficult procedures like sufficient desufflation, avoiding excessive force in manual maneuvers, and prevent loop formation.

Rare complication of colonoscopy – complicated cholelithiasis

Rare complication of colonoscopy – complicated cholelithiasis

Spelenic Hematoma: An Uncommon Complication of Routine Colonoscopy

Introduction: Colonoscopy is the vital diagnostic and therapeutic tool in the management of patients with bleeding polyps and lesions of the lower gastrointestinal tract. While it is a minimally invasive procedure, it is not exempt from complications. We describe a case of splenic laceration with subscapular hematoma as a serious complication of colonoscopy. Case: A 59-year-old male with a history of anemia and COPD presented to the emergency department with abdominal pain for the past 24 hours. He had undergone colonoscopy two days prior for evaluation of chronic anemia which did not identify any cause for his anemia. He denies fever, hematochezia, vomiting and has been able to tolerate his diet. In the ED. he was noted have blood pressure 95/58,heart rate 61.His abdomen was soft - but tender to palpation in epigastrium and LUQ with no rebound. Blood count showed a decrease in hemoglobin (10.9 to 8.5 g/dL), with platelet count of 177 10(3)/mcl, INR (1.1) and Liver enzymes (AST U/L 24; ALT U/L 43; Total Bilirubin 0.7 mg/dl). CT abdomen with contrast exhibited splenic hematoma measuring 14 x 9.5x11.6cm (Image 1, 2) while a follow up CT two day later showed slightly increased hematoma measuring 14 x 10 x 13 (Image 3) Patient refused invasive intervention including laparotomy and angiography. He was treated conservatively with close clinical and laboratory monitoring. Conclusion: Splenic laceration was first described by Zehner in 1974 as complication of colonoscopy. While the reported incidence ranges between 0.00005% and 0.017%, it carries mortality rate of 5%. Most patient present within 48 hours after the procedure with hypotension, anemia, leukocytosis, abdominal pain/distension, and Kehr's sign. External force or pressure on the splenocolic ligament during passage through the splenic flexure is the most likely cause of splenic injury. Previous surgeries leading to intra-abdominal adhesions is also thought to be a contributing factor. In an effort to prevent such trauma, positioning the patient in a left lateral position allows the spleen to fall to the left and prevents opposing splenic and colonic tension. However, with increasing number of colonoscopies as a result of our aging population, the incidence of splenic complication are expected to rise. This case highlights the importance of early recognition, diagnosis and prompt treatment in an effort improve outcome.Figure 1Figure 2Figure 3

Perforated Appendicitis as a Complication of Colonoscopy: A Case Report and Review of Literature

Perforated Appendicitis as a Complication of Colonoscopy: A Case Report and Review of Literature