# Behind the Ink: Unmasking Asymptomatic Micro-perforations Following Endoscopic Tattooing

## TL;DR

A case study shows a patient had an asymptomatic micro-perforation after endoscopic tattooing, suggesting that close observation may be sufficient in such cases.

## Contribution

This paper reports a rare case of asymptomatic micro-perforation following endoscopic tattooing and suggests the need for further large-scale studies.

## Key findings

- A 49-year-old male had an asymptomatic micro-perforation detected incidentally after endoscopic tattooing.
- The patient recovered successfully with supportive treatment and no additional interventions.
- The study highlights the need for further research to understand the correlation between tattooing and micro-perforations.

## Abstract

Endoscopic tattooing is a valuable tool for identifying gastrointestinal lesions following initial discovery during endoscopy. Although generally considered safe, with minimal complications, routine post-procedure imaging is not practiced, and the detection of micro-perforation after tattooing is even rarer. We present a case of a 49-year-old male who underwent a colonoscopy for a workup of anemia, revealing a malignant-appearing mass in the ascending colon. The lesion was tattooed for further assessment. A follow-up CT scan for evaluation of metastatic disease incidentally demonstrated acute inflammatory changes and trace gas, consistent with micro-perforation. The patient was asymptomatic and hemodynamically stable on supportive treatment, with subsequent successful recovery. Therefore, close observation without additional interventions could be considered in patients with incidental micro-perforations and no symptoms. A large-scale study is needed to further demonstrate the correlation between endoscopic tattooing and micro-perforations to avoid unnecessary extensive evaluation.