Derailing the Ex‐Lap Train: A 62‐Year‐Old Woman with Peritonitis After Colonoscopy

1UNC Hospitals, Chapel Hill, NC
2UNC Hospitals, Chapel Hill, NC

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 397

Case Presentation:

A 62‐year‐old woman presented with the acute onset of severe abdominal pain of approximately 6 hours duration. Earlier that day, she had undergone a colonoscopy, during which one 18‐mm sessile polyp was removed. She tolerated the procedure well and there were no reported complications. She felt well after the procedure and returned home, but 2 hours afterwards developed abdominal pain, which was located in the left lower quadrant and described as severe, sharp, constant and without radiation. She denied fevers, chills, nausea, vomiting, or diarrhea. Pulse was 100 and temperature 37.4. Abdomen had active bowel sounds, was nondistended, soft and diffusely tender without rebound tenderness or guarding. Tenderness was most notable in left lower quadrant. WBC was 15.6. Plain film revealed no evidence of pneumoperitoneum, with a nonobstructive gas pattern. CT of the abdomen also revealed no evidence of pneumoperitoneum She was started on ciprofloxacin and metronidazole and brought into the hospital for observation. Twelve hours after presentation, the patient's pain had greatly improved and she was tolerating a full diet. She was discharged home in good condition to complete a 5‐day course of oral antibiotics.

Discussion:

The general internist should be aware of postpolypectomy syndrome, an uncommon but well described complication of colonoscopy. Between 0.5% and 1.2% of patients who undergo a colonoscopy with polypectomy will develop this complication. Postpolypectomy syndrome occurs when the electrical current used to remove a polyp extends past the mucosa and involves the muscularis propria and serosa but leaves the lumen intact. This results in local inflammation and peritonitis without true perforation. Factors that appear to increase risk of postpolypectomy syndrome include sessile morphology and size >2 cm. Patients typically present within 12 hours of the procedure and have localized tenderness, fevers and leukocytosis. Definitive exclusion of perforation requires abdominal CT. Typically, perilumenal fat stranding will be seen without pneumoperitoneum. Conservative treatment is indicated and includes IV fluids, bowel rest and antibiotics. An antibiotic regimen that targets bowel flora, such as ciprofloxacin and metronidazole, should be used. Duration of therapy is based on clinical response and can extend up to 5 days. Surgical intervention is not necessary.

Conclusions:

Given the volume of colonoscopies performed in the United States., it is important for the general internist to be able to recognize endoscopic complications and treat them or refer appropriately, helping patients avoid unnecessary surgery.

To cite this abstract:

Stephens J, Austin C. Derailing the Ex‐Lap Train: A 62‐Year‐Old Woman with Peritonitis After Colonoscopy. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 397. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/derailing-the-exlap-train-a-62yearold-woman-with-peritonitis-after-colonoscopy/. Accessed May 26, 2019.

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