A119 ACUTE COLONOC PSEUDO-OBSTRUCTION AFTER ENDOSCOPIC RESECTION OF A FULLY CIRCUMFERENTIAL LARGE NON-PEDUNCULATED COLORECTAL POLYP

TL;DR

This case report describes a rare complication of acute colonic pseudo-obstruction following endoscopic removal of a large colorectal polyp.

Contribution

The paper presents the first reported case of acute colonic pseudo-obstruction after endoscopic resection of a fully circumferential large non-pedunculated polyp.

Findings

A 91-year-old male developed acute colonic pseudo-obstruction after endoscopic mucosal resection of a 100mm polyp.

The patient required hospitalization and conservative management, including nasogastric decompression, for a total of 9 days.

This case highlights the importance of recognizing rare adverse events following minimally invasive endoscopic procedures.

Abstract

Complex large non-pedunculated colorectal polyps (LNPCPs), including those involving the full circumference of the bowel, are now readily managed by minimally invasive endoscopic resection techniques. Established procedure-related adverse events include sedation related adverse events, deep mural injury, clinically significant post-resection bleeding, delayed perforation and serositis. An appreciation for potential procedure-related adverse events is critical to the effective implementation of these techniques.

To describe a case of acute colonic pseudo-obstruction after endoscopic resection of a fully circumferential LNPCP.

Case report and review of the literature

A 91-year-old male with a history of atrial fibrillation, chronic kidney disease and suspected McKittrick-Wheelock syndrome underwent successful endoscopic mucosal resection (EMR) of a 100mm fully circumferential LNPCP in the sigmoid colon. Histopathology diagnosed a tubulovillous adenoma with high-grade dysplasia. After elective admission, he suffered from clinically significant post-EMR bleeding requiring 2 units of packed red blood cells. On post-operative day 1 he began to suffer from nausea, abdominal pain and obstipation. On examination, he was visibly distended. Abdominal X-ray revealed extensive gas-filled loops of small and large bowel with the absence of gas in the rectum. He was managed conservatively with nasogastric tube decompression. Total duration of hospital stay was 9 days.

Critical to the continued expansion of minimally invasive endoscopic resection techniques is an awareness for potential procedure-related adverse events. To our knowledge this is the first description of acute colonic pseudo-obstruction after endoscopic resection

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