Chen FZ, Ouyang L, Zhong XL, Li JX, Zhou YY. Postpolypectomy syndrome without abdominal pain led to sepsis/septic shock and gastrointestinal bleeding: A case report. World J Gastrointest Surg 2023; 15(10): 2343-2350 [PMID: 37969719 DOI: 10.4240/wjgs.v15.i10.2343]
Corresponding Author of This Article
Yan-Yan Zhou, MD, PhD, Attending Doctor, Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha 410011, Hunan Province, China. iamzhouyanyan@csu.edu.cn
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2343-2350 Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2343
Postpolypectomy syndrome without abdominal pain led to sepsis/septic shock and gastrointestinal bleeding: A case report
Fang-Zhi Chen, Lin Ouyang, Xiao-Li Zhong, Jin-Xiu Li, Yan-Yan Zhou
Fang-Zhi Chen, Department of Gastroenterology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421001, Hunan Province, China
Lin Ouyang, Xiao-Li Zhong, Jin-Xiu Li, Yan-Yan Zhou, Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Chen FZ and Zhou YY prepared the manuscript; Zhou YY, Ouyang L, and Zhong XL contributed to the clinical observations, material preparation, and image collection; Ouyang L and Zhong XL interpreted the laboratory results and computed tomography images; Chen FZ, Li JX and Zhou YY reviewed the manuscript; all authors contributed to the study conception and design and read and approved the final manuscript.
Supported bythe Scientific Research Project of the Natural Science Foundation of Changsha, No. kq2202413.
Informed consent statement: We obtained the patient's written informed consent to disclose his case. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that his name will not be published, and due efforts will be made to conceal his identity.
Conflict-of-interest statement: All authors declare no competing financial interests for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Yan Zhou, MD, PhD, Attending Doctor, Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha 410011, Hunan Province, China. iamzhouyanyan@csu.edu.cn
Received: July 20, 2023 Peer-review started: July 20, 2023 First decision: August 5, 2023 Revised: August 15, 2023 Accepted: September 5, 2023 Article in press: September 5, 2023 Published online: October 27, 2023 Processing time: 99 Days and 0.5 Hours
Abstract
BACKGROUND
Postpolypectomy syndrome (PPS) is a rare postoperative complication of colonic polypectomy. It presents with abdominal pain and fever accompanied by coagulopathy and elevated inflammatory markers. Its prognosis is usually good, and it only requires outpatient treatment or observation in a general ward. However, it can be life-threatening.
CASE SUMMARY
The patient was a 58-year-old man who underwent two colonic polypectomies, each resulting in life-threatening sepsis, septic shock, and coagulopathy. Each of the notable manifestations was a rapid drop in blood pressure, an increase in heart rate, loss of consciousness, and heavy sweating, accompanied by shortness of breath and decreased oxygen in the finger pulse. Based on the criteria of organ dysfunction due to infection, we diagnosed him with sepsis. The patient also experienced severe gastrointestinal bleeding after the second operation. Curiously, he did not complain of any abdominal pain throughout the course of the illness. He had significantly elevated concentrations of inflammatory markers and coagulopathy. Except for the absence of abdominal pain, his fever, significant coagulopathy, and elevated inflammatory marker concentrations were all consistent with PPS. Abdominal computed tomography and superior mesenteric artery computed tomography angiography showed no free air or vascular damage. Thus, the diagnosis of colon perforation was not considered. The final blood culture results indicated Moraxella osloensis. The patient was transferred to the intensive care unit and quickly improved after fluid resuscitation, antibiotic treatment, oxygen therapy, and blood transfusion.
CONCLUSION
PPS may induce dysregulation of the systemic inflammatory response, which can lead to sepsis or septic shock, even in the absence of abdominal pain.
Core Tip: Postpolypectomy syndrome (PPS) is a rare postoperative complication of colonic polypectomy. The prognosis is usually good, and it is characterized by abdominal pain, fever, inflammatory markers, and abnormal coagulation. We report a 58-year-old man who developed life-threatening sepsis or septic shock and gastrointestinal bleeding after colonic polypectomy. Except for the absence of abdominal pain, the patient presented with characteristic PPS symptoms of fever, significant coagulation abnormalities, and elevated inflammatory markers. Final blood culture indicated Moraxella osloensis. This case implies that abdominal pain is not a necessary symptom of PPS, and PPS without abdominal pain may progress to life-threatening sepsis and bleeding.
