Intramural Hematoma, a Rare Complication of Colonoscopy

1John H Stroger Hospital of Cook County, Chicago, IL

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 324

Case Presentation:

A 60‐year old man was admitted because of acute alcohol intoxication with altered mental status and ataxia. He was treated initially for Wernicke encephalopathy. Patient underwent physical therapy. Laboratory results revealed mild iron deficiency anemia. A colonoscopy was performed, and one 2 mm polyp was removed, without complications. Ten hours after the procedure, he started complaining of severe left upper quadrant abdominal pain. Vitals showed tachycardia, examination revealed left upper quadrant tenderness with no guarding, rebound or rigidity, no evidence of rectal bleeding. Computed Tomography (CT) scan showed, a large high density upper quadrant retroperitoneal mass measuring 7 x 8 x 10cm suggestive of a hematoma arising from the bowel wall. There was a 3 g/dL drop in hemoglobin level. Repeat abdominal CT 6 hours later did not show an increase in size of the hematoma. He received a transfusion of 2 units of Red Blood Cells (RBC) and was monitored for 48 hours for any further increase in hematoma size in the intensive care unit and assisted by the Colorectal surgery team. Five days later, the patient was discharged after clinical improvement and confirmed radiologically stable abdominal hematoma.

Discussion:

Intramural hematoma of the colon is a rare but life‐threatening complication of colonoscopy. It has been reported in elderly people taking anticoagulants. Findings suggestive of this diagnosis include; a recent history of colonoscopy, unremitting abdominal pain, rectal bleeding, acute anemia and/or hemodynamic instability. The two main mechanisms of intramural hematoma formation include: a contusion injury of the wall of the colon and/or a partial wall thickness laceration. Intramural hemorrhage due to traumatic injury during colonoscopy is more common at hepatic and splenic flexure due to the increased tension exerted there. A CT scan or a repeat colonoscopy are best utilized to confirm the diagnosis. The choice of conservative therapy versus surgery vary from patient to patient based on overall clinical status and the extent of injury. The importance of early imaging cannot be overemphasized, not only to diagnose but also to rule out other serious and possibly catastrophic complications post colonoscopy.

Conclusions:

Intracolonic mural hematomas are a rare complication of colonoscopy. Diagnosis is best attained with a CT scan or a repeat colonoscopy. Surgical treatment may be indicated if patient is hemodynamically unstable or if hematoma is increasing

To cite this abstract:

Arora M, Bhavsar S, Ezeife I, Verda L, Tzonkov A. Intramural Hematoma, a Rare Complication of Colonoscopy. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 324. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/intramural-hematoma-a-rare-complication-of-colonoscopy/. Accessed July 22, 2019.

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