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Iatrogenic sinistral hypertension complicating screening colonoscopy
Oliver J Ziff1, A M James Shapiro
1Department of Surgery, University of Alberta, 2000 College Plaza, 8215 112th Street, Edmonton, AB, Canada T6G 2C8.
Case Reports in Surgery
|September 12, 2013
Summary
Colonoscopy can cause colon perforation, a rare complication. This case highlights a delayed upper gastrointestinal bleed due to splenic vein thrombosis and gastric varices following conservative management of iatrogenic colon perforation.
Area of Science:
- Gastroenterology
- Surgical Complications
Background:
- Colonoscopy is the gold standard for detecting colorectal cancer but carries risks, including iatrogenic colonic perforation.
- Conservative management of colonic perforation may lead to delayed complications.
Purpose of the Study:
- To report a rare case of delayed upper gastrointestinal bleeding after colonoscopy-induced colonic perforation.
- To discuss the pathophysiology of sinistral hypertension and gastric varices in this context.
- To advocate for prompt surgical intervention in selected cases of iatrogenic colonic perforation.
Main Methods:
- Case report of a patient with colonoscopy-induced perforation.
- Conservative management followed by delayed presentation with upper gastrointestinal bleed.
- Diagnostic investigations including Oesophago-gastro-duodenoscopy (OGD) and computed tomography (CT).
- Surgical exploration, abscess identification, and splenectomy.
Main Results:
- The patient developed splenic vein thrombosis and gastric fundal varices 18 months post-perforation, attributed to sinistral (left-sided) hypertension.
- A persistent abscess grew Streptococcus anginosus.
- Splenectomy resulted in full recovery.
Conclusions:
- Iatrogenic colonic perforation can lead to late-onset sinistral hypertension and gastrointestinal bleeding.
- Prompt surgical intervention in selected cases of colonic perforation may prevent such delayed complications.
- Surgical management, including splenectomy, can be curative for complications arising from splenic vein thrombosis.
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