transmural colonic infarction after routine colonoscopy in a young patient without risk factors

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ID: 242549
2016
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Abstract
Colonoscopy is one of the most widely used procedures in medical practice for the diagnosis and treatment of many benign and malignant diseases of the colorectal tract. Colonscopy has become the reference procedure for screening and surveillance of colorectal cancer. The overall rate of adverse events is estimated to be about 2.8 per 1,000 procedures, while complications requiring hospitalization are about 1.9 per 1,000 colonoscopies. Mortality from all causes and colonoscopy-specific mortality are estimated to be 0.07 and 0.007%, respectively. An exceptional fearsome postcolonoscopy complication is colon ischemia (CI); only few cases have been reported worldwide. We present the case of a 43-year-old woman who presented to the emergency department complaining of abdominal pain; fever and rectal bleeding appeared 12 h after a voluntary ‘screening’ colonoscopy. She had no risk factors for CI. Her laboratory tests showed alterations in inflammatory markers and a computed tomography scan showed a circumferential thickening in the left colon and free fluid in the abdomen. After 12 h of observation and conservative therapy, the clinical state of the patient worsened with the rising of signs of peritonitis. Laparoscopy showed that colon infarction extended from the distal third of the transverse colon to the proximal rectum. Laparotomy, resection of the pathological colon and terminal colostomy were performed. The specimen examined confirmed an extended ischemic colitis and transmural infarction on the antimesocolic side, in the absence of a vasculitis. The patient underwent recanalization after 8 months. CI after colonoscopy is a rare and alarming complication that must be known and taken into account in the differential diagnosis of symptomatic cases after colonoscopy, particularly in patients with known risk factors. The diagnosis is mainly based on clinical data, imaging and especially endoscopy. Treatment is almost always conservative but, in some cases in which the pathological process appears irreversible, surgery becomes mandatory.
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zizzo2016casetransmural Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Maurizio Zizzo;Carolina Castro Ruiz;Lara Ugoletti;Alessandro Giunta;Stefano Bonacini;Lorenzo Manzini;Fabrizio Aguzzoli;Alberto Colognesi;Claudio Pedrazzoli
Journal trends in genetics : tig
Year 2016
DOI
10.1159/000448884
URL
http://www.karger.com/Article/FullText/448884
Keywords
Risk factors colonoscopy Gastroenterology surgerydiseases of the digestive system

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