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Subacute reaction to endoscopic mucosal resection mimicking perforation
J M L Williamson1, P Dunkley, D Hewin
1Gloucestershire Hospitals NHS Foundation Trust, UK. jmlw@doctors.org.uk
Annals of the Royal College of Surgeons of England
|May 23, 2012
Summary
Endoscopic mucosal resection (EMR) for colonic polyps can cause severe abdominal pain due to potential injury. Prompt CT scans are recommended for patients with post-EMR pain, with conservative management suitable for non-perforated cases.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Endoscopic mucosal resection (EMR) is a common procedure for removing colonic polyps.
- Post-procedure complications, though rare, require clinical awareness.
Observation:
- A 25-year-old woman presented with severe abdominal pain six hours after EMR of ascending colon polyps.
- Clinical examination revealed tenderness and peritonism in the right lower quadrant.
- Abdominal CT showed colonic wall thickening and edema, but no free air or fluid.
Findings:
- The patient was managed conservatively due to the absence of radiological signs of perforation.
- Full recovery was achieved, suggesting a non-perforative complication.
- Possible etiologies include post-polypectomy electrocoagulation injury, localized ischemia from adrenaline, or an allergic reaction to dye.
Implications:
- Clinicians should maintain a high index of suspicion for complications following EMR.
- Prompt CT investigation is crucial for patients presenting with abdominal pain post-EMR.
- Conservative management is a viable option for patients without evidence of perforation.
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