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DOI: 10.1055/s-0032-1326345
Ceco-colic intussusception with subsequent bowel infarction as a rare complication of colonoscopic polypectomy
Publication History
Publication Date:
22 March 2013 (online)
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A 47-year-old man underwent a colonoscopic polypectomy to treat a cecal adenoma detected during a screening colonoscopy. The initial colonoscopy showed a 15-mm, nonpolypoid lesion (0-IIa type) located at the cecal base ([Fig. 1]). After a submucosal injection of 4 mL of diluted epinephrine solution (1 : 10 000), the lesion was successfully resected en bloc using a standard snare and electrical current and without complications. Prophylactic hemoclipping was carried out to prevent postprocedural bleeding. Total time taken for the colonoscopy was about 14 minutes.
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At 12 hours after the procedure, the patient complained of colicky abdominal pain. Physical examination disclosed localized tenderness in the right lumbar region. Laboratory studies revealed peripheral blood leukocytosis (13 320/μL) with neutrophilia (88.9 %), increased levels of C-reactive protein (1.0 mg/dL), and normal hemoglobin (14.1 g/dL). A plain abdominal film excluded pneumoperitoneum. We carried out urgent abdominal computed tomography (CT), which demonstrated a typical targetlike lesion with telescoping of the cecum into the ascending colon ([Fig. 2]). Follow-up colonoscopy revealed a markedly congested masslike lesion, which was proven to be the swollen cecal wall as a lead point of intussusception. There was also prominent mucosal discoloration, edema, and exudation in the cecum, suggestive of acute bowel ischemia ([Fig. 3]) ([Video 1]). Based on the colonoscopic findings, the patient underwent emergency laparoscopic right hemicolectomy. The pathologic examination confirmed ceco-colic intussusception with ischemic infarction in the cecum without evidence of perforation ([Fig. 4]).
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Quality:
Intussusception after colonoscopy is an extremely rare phenomenon [1] [2] [3] [4]. This unique case highlights the need to consider intussusception as a serious complication of colonoscopic polypectomy. We presume that the precipitating mechanisms included bowel edema secondary to a transmural burn and localized ischemia induced by epinephrine used for submucosal lifting. Paradoxically, colonoscopy can be useful for the immediate diagnosis of bowel ischemia secondary to intussusception.
Endoscopy_UCTN_Code_CPL_1AJ_2AC
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References
- 1 Azar T, Berger DL. Adult intussusception. Ann Surg 1997; 226: 134-138
- 2 Wang N, Cui XY, Liu Y et al. Adult intussusception: a retrospective review of 41 cases. World J Gastroenterol 2009; 15: 3303-3308
- 3 Ho MM, Park JJ, Prasad LM. Post colonoscopy colonic intussusception reduced via a laparoscopic approach. JSLS 2010; 14: 596-599
- 4 Nachnani J, Burns E, Margolin D et al. Colocolonic intussusception after colonoscopy. Gastrointest Endosc 2012; 75: 223-225