INTRODUCTION: Colonoscopic polypectomies have been the mainstay in polyp removal since the 1970s and are associated with a much better morbidity and mortality than surgery. However, clinically evident bleeding can occur in 0.2-1.0% of cases. Herein lies a case report of postpolypectomy bleeding following a routine esophagogastroduodenoscopy and colonoscopy. We also discuss the risk factors and management of these patients. CASE DESCRIPTION/METHODS: Patient is a 77 year old male who present to the Emergency Department from home after an elective EGD and colonoscopy earlier that day. The patient was found to have a deep antral polyp and required cautery. A sigmoid polyp was also found, and was removed. After the elective procedure earlier in the day, the patient denied any signs overt bleeding. However, upon returning home he felt very weak. The patient had a bloody bowel movement at home and became pale and diaphoretic. Patient was taken to Emergency Department and found to be hypotensive at 60/40 mmHg and had a witnessed episode of hematemesis. Hemoglobin on admission was 8.0 g/dL. Protonix drip was started yet despite a 1L bolus of saline and 2 units of RBCs in ED, patient remained unstable. His AIMS65 score was 3 which was indicative of a 10.3% mortality. Patient was on coumadin for afib but it was held 5 days prior to procedures. Overnight patient had a 3 more bloody bowel movements and 5 more units of RBCs given, however he remained hypotensie and required ICU monitoring and norepinephrine. Emergent EGD revealed no active bleeding but a large 2 cm clean based ulcer where antral polypectomy occurred earlier. No intervention was done due to lack of active bleeding and size of ulcer. By day 9 patient had hemodynamically stabilized and biopsy from initial endoscopy resulted as hyperplastic histology concerning for mild dysplasia. DISCUSSION: Bleeding can occur immediately following a polypectomy or can be delayed from hours to weeks. Delayed PPB can occur due to sloughing of eschar or scab that covered a blood vessel, or an increasing zone of necrosis induced by the thermal energy used to resect the polyp and cauterize the site. Rates of delayed PPB range from 0.02-2.0% with a variety of risk factors. The larger the polyp, the higher the risk of PPB with some reports indicating an increase incidence of 9-13% for every 1 mm in polyp diameter. Patients should have any antiplatelet therapy held, with the exclusion of aspirin, prior to these procedures. NSAIDs should be avoided up to two weeks after polypectomies.

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