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Unexplained septic shock after colonoscopy with polyethylene glycol preparation in a young adult: A case report
Jiao-Jiao Song1, Chen-Jiao Wu1, Yuan-Yuan Dong1
1Department of Gastrointestinal Endoscopy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
Insights
Septic shock is a rare complication following colonoscopy with polyethylene glycol (PEG) bowel preparation, even in healthy young adults. This case highlights the need for vigilance regarding potential opportunistic infections post-procedure.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Infectious Disease
Background:
- Colonoscopy is a routine examination, with polyethylene glycol (PEG) widely used for bowel preparation due to its safety and cost-effectiveness.
- Septic shock post-colonoscopy with PEG preparation is exceptionally rare, typically observed only in critically ill patients.
Observation:
- A healthy 33-year-old male developed septic shock with elevated inflammatory markers (WBC, CRP, procalcitonin) two days after a colonoscopy with PEG preparation.
- The patient had a history of recurrent diarrhea but no other significant pre-existing conditions; colonoscopy revealed normal findings.
Findings:
- Despite aggressive resuscitation and antibiotic treatment, blood and stool cultures failed to identify a causative pathogen.
- The clinical presentation strongly suggested septic shock, despite the absence of a confirmed microbial source.
Implications:
- This case underscores the rare but serious risk of septic shock following PEG-induced bowel preparation, particularly in younger, otherwise healthy individuals.
- Opportunistic infections may play a role, necessitating heightened clinical surveillance for post-colonoscopy complications.
- Further research into the mechanisms of post-PEG septic shock is warranted to improve patient safety.
Background:
Colonoscopy has become a routine physical examination as people's health awareness has increased. Polyethylene glycol (PEG) is greatly used in bowel preparation before colonoscopy due to its price and safety advantages. Septic shock after colonoscopy with PEG preparation is extremely rare, with only very few cases in critically ill patients. Herein, we describe a case of septic shock in a healthy young adult immediately following colonoscopy with PEG preparation.
Case Summary:
A 33-year-old young adult presented to our hospital for colonoscopy with PEG bowel preparation due to recurrent diarrhea for 7 years. The male's previous physical examination showed no abnormal indicators, and colonoscopy results were normal; however, he exhibited septic shock and markedly elevated white blood cell, C-reactive protein, and procalcitonin levels on the second day after colonoscopy. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition. However, the blood and stool cultures did not detect the pathogen.
Conclusion:
Septic shock after colonoscopy is rare, especially in young adults. The authors considered the possibility of opportunistic infections after PEG bowel preparation, and clinicians should monitor patients for the possibility of such complications.
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