Case Report
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World J Gastrointest Endosc. Sep 16, 2013; 5(9): 455-456
Published online Sep 16, 2013. doi: 10.4253/wjge.v5.i9.455
Abdominal pain post endoscopic mucosal resection: Treat the patient not the CT scan
Neel Heerasing, Damian Dowling, Sina Alexander
Neel Heerasing, Damian Dowling, Sina Alexander, Department of Gastroenterology, Barwon Health, Geelong, Victoria 3220, Australia
Author contributions: Heerasing N was the primary author of the case; Dowling D and Alexander S were involved in editing the manuscript.
Correspondence to: Neel Heerasing, MBBS, Gastroenterology Registrar, Department of Gastroenterology, Barwon Health, Bellerine St, Geelong, Victoria 3220, Australia. neel.heerasing@gmail.com
Telephone: +61-3-42150000 Fax: +61-3-42152301
Received: July 15, 2013
Revised: August 15, 2013
Accepted: August 20, 2013
Published online: September 16, 2013
Processing time: 61 Days and 1.8 Hours
Abstract

An 85-year-old female, with hereditary nonpolyposis colorectal cancer syndrome, underwent a colonoscopy and endoscopic mucosal resection (EMR) of a 25-mm proximal ascending colon polyp (Paris classification 0-Is). Post-procedure, the patient developed abdominal pain in the right iliac fossa which settled 1 h later. An urgent computed tomography (CT) scan of her abdomen was organised which happened 6 h post onset of abdominal pain. She had radiological evidence of perforation on the CT scan but clinically remained well and was managed conservatively. The exact aetiology of this patient’s symptoms is not known. We suspect the radiological findings are probably due to a combination of injectate within the colonic wall and leakage of insufflated air or CO2 following transmural passage of the EMR needle. As EMR is becoming an increasingly effective treatment modality in the management of large sessile polyps, clinicians need to be aware of potential complications of treatment. It is also important to recognise that radiological features of perforation can be seen post EMR in the absence of an EMR associated perforation.

Keywords: Colonoscopy; Endoscopic mucosal resection; Perforation; Computed tomography scan; Abdominal pain

Core tip: This report highlights the importance of correlating clinical findings with radiological ones in a patient who underwent endoscopic mucosal resection of a large ascending polyp. The computed tomography scan in this case reveals a colonic perforation but the patient was symptom free and was managed conservatively without needing surgery. Colonoscopists who undertake endoscopic mucosal resection (EMR) need to be aware that radiological features of perforation can be seen post EMR in the absence of an EMR associated perforation.