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Colonic explosion during endoscopic polypectomy: avoidable complication or bad luck?

D F G M Josemanders¹, E J Spillenaar Bilgen, A A van Sorge

¹Department of Hepatology and Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands. djosemanders@alysis.nl

|October 5, 2006

Summary

A colonic explosion occurred during a colon polypectomy due to combustible gas concentrations. This rare event required emergency surgery and highlights the need for strategies to prevent future colonic explosions.

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Area of Science:

Gastroenterology
Surgical Complications
Medical Device Safety

Background:

Colonic polypectomy using snare loop electrocautery is a common endoscopic procedure.
Intraluminal colonic explosions are rare but severe complications.
Combustible gases like hydrogen and methane can accumulate in the colon.

Observation:

A patient undergoing colonic polypectomy experienced an intraluminal colonic explosion.
The explosion resulted in multiple colonic lacerations.
Immediate surgical intervention, including right hemicolectomy and sigmoid resection, was necessary.

Findings:

The explosion was likely caused by ignitable concentrations of hydrogen and/or methane.
Factors contributing to gas accumulation include colonic bacteria, fecal matter, cleansing solutions, and oxygen insufflation.
The patient required extensive surgical repair due to the severity of the lacerations.

Implications:

This case underscores the potential risks associated with electrocautery during colonoscopy.
Strategies to mitigate intraluminal gas accumulation and prevent colonic explosions should be explored.
Further research is needed to identify and implement preventative measures for this rare but dangerous complication.