A Case of Post-polypectomy Syndrome Following Endoscopic Resection of a Rectal Polyp

Post-polypectomy syndrome (PPS) is a rare yet significant complication of endoscopic polypectomy that can clinically mimic intestinal perforation. This report presents the case of an 85-year-old female who developed PPS following an elective endoscopic mucosal resection (EMR) of a 3 cm mid-rectal polyp. Her past medical history included asthma and epilepsy. The EMR was performed in a piecemeal fashion using snare tip soft coagulation, and the defect was closed with eleven endoclips. The patient initially remained stable post-procedure but developed pyrexia, drowsiness, and a Glasgow Coma Scale (GCS) score of 3/15 later that evening. Laboratory results revealed severe metabolic acidosis, elevated lactate, markedly raised inflammatory markers, and significant leukocytosis. A contrast-enhanced CT scan of the abdomen and pelvis showed no evidence of perforation or obstruction but did reveal rectal wall edema, fat stranding, and a small-to-moderate volume of pelvic free fluid. These findings, in conjunction with her recent procedure and clinical deterioration, led to a diagnosis of PPS. She was managed conservatively with intravenous fluids and piperacillin-tazobactam; she made a full recovery and was discharged within 72 hours. This report underscores the importance of early recognition and differentiation of PPS from true bowel perforation. PPS is typically self-limiting and can be managed non-surgically with close monitoring. A thorough awareness of the risk factors-such as large polyp size, use of thermal coagulation, and rectal location-can assist in early diagnosis and prevent unnecessary surgical intervention. This report highlights the need for high clinical suspicion, timely imaging, and prompt supportive treatment in patients who deteriorate following endoscopic interventions.