Colonoscopy complications: Difference between revisions
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**peritoneal inflammation without frank perforation | **peritoneal inflammation without frank perforation | ||
**[[abdominal pain]], [[fever]], [[leukocytosis]] | **[[abdominal pain]], [[fever]], [[leukocytosis]] | ||
*[[Infection]]: bacteremia, retroperitoneal abscess, [[appendicitis]] | *[[Infection]]: [[bacteremia]], retroperitoneal abscess, [[appendicitis]] | ||
*Colonic distension, precipitation of [[toxic megacolon]] | *Colonic distension, precipitation of [[toxic megacolon]] | ||
*[[Myocardial infarction]], [[PE]] (if off anticoagulation) | *[[Myocardial infarction]], [[PE]] (if off anticoagulation) | ||
*Gas explosion | *Gas explosion | ||
**methane (in flatus) + electrocautery | **methane (in flatus) + electrocautery → BOOM! | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 25: | Line 25: | ||
*CBC | *CBC | ||
*Coags, T&S if bleeding | *Coags, T&S if bleeding | ||
*CXR for free air if concern for perforation | *[[CXR]] for free air if concern for perforation | ||
*CT abdomen/pelvis (if presentation concerning for intra-abdominal bleed, infection, or perforation) | *CT abdomen/pelvis (if presentation concerning for intra-abdominal bleed, infection, or perforation) | ||
==Management== | ==Management== | ||
*[[PRBC]] transfusion, reverse coagulopathy if significant bleed | *[[PRBC]] transfusion, reverse coagulopathy if significant bleed | ||
*Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or abscess | *Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or [[abscess]] | ||
*Antibiotics if concern for perforation or infection | *Antibiotics if concern for perforation or infection | ||
**See [[peritonitis]] | **See [[peritonitis]] | ||
Latest revision as of 20:00, 17 September 2019
Background
- Over 85% of the serious colonoscopy complications are reported in patients undergoing colonoscopy with polypectomy (7-fold increase)[1]
Clinical Features
- Hemorrhage
- Most common complication
- Caused by polypectomy, biopsy, mucosal lacerations, mesenteric or splenic tears
- Rectal bleeding (if intraluminal)
- Intra-abdominal bleed (if mesenteric or splenic trauma)
- Perforation
- Post-polypectomy electrocoagulation syndrome
- peritoneal inflammation without frank perforation
- abdominal pain, fever, leukocytosis
- Infection: bacteremia, retroperitoneal abscess, appendicitis
- Colonic distension, precipitation of toxic megacolon
- Myocardial infarction, PE (if off anticoagulation)
- Gas explosion
- methane (in flatus) + electrocautery → BOOM!
Differential Diagnosis
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
- CBC
- Coags, T&S if bleeding
- CXR for free air if concern for perforation
- CT abdomen/pelvis (if presentation concerning for intra-abdominal bleed, infection, or perforation)
Management
- PRBC transfusion, reverse coagulopathy if significant bleed
- Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or abscess
- Antibiotics if concern for perforation or infection
- See peritonitis
Disposition
See Also
External Links
References
- ↑ Complications of colonoscopy. GASTROINTESTINAL ENDOSCOPY Volume 74, No. 4 : 2011