Delayed perforation after cold snare polypectomy for small colonic polyps in a patient receiving oral corticosteroids

Iwano, Hirotoshi; Sato, Takayuki; Ishii, Yoshifumi; Niki, Suguru; Sawaya, Reiji; Tamakawa, Susumu; Yamada, Masataka

doi:10.1002/deo2.157

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…in 2022. 4 However, in that particular case, on the day after the procedure, the patient had developed postoperative hemorrhage, which was controlled by the use of additional clips at the suspected sites of bleeding, but not at the site of the delayed perforation. Moreover, the interval between the CSP and delayed perforation was as long as 8 days.…”

Section: Discussionmentioning

confidence: 91%

“…To date, there has been only one reported case of delayed perforation after CSP, by Iwano et al. in 2022 4 . However, in that particular case, on the day after the procedure, the patient had developed postoperative hemorrhage, which was controlled by the use of additional clips at the suspected sites of bleeding, but not at the site of the delayed perforation.…”

Section: Discussionmentioning

confidence: 99%

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A case of delayed perforation after cold snare polypectomy treated conservatively by endoscopic clip closure

Iida,

Minato,

Banjoya

et al. 2023

DEN Open

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We present the case of a 45‐year‐old man who underwent a screening total colonoscopy and developed delayed perforation after a cold snare polypectomy in the descending colon and sigmoid colon. The patient developed abdominal pain and was referred to our department for further evaluation and treatment. On clinical examination, we noted lower abdominal tenderness, mild rebound pain, and elevated levels of inflammatory markers. Abdominal contrast‐enhanced computed tomography confirmed the presence of free air in the abdomen. Since there were no signs of peritoneal inflammation and the vital signs were stable, we planned to perform endoscopic clip closure of the perforated area. The patient's symptoms improved with conservative management thereafter, including fasting, fluid replacement, and antibiotic administration. The patient was discharged on the 6th hospital day. In this case report, we discuss the usefulness of endoscopic clip closure in managing delayed perforation.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A case of delayed perforation after cold snare polypectomy treated conservatively by endoscopic clip closure

Iida,

Minato,

Banjoya

et al. 2023

DEN Open

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A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon

Kodama,

Mizokami,

Toyama

et al. 2024

DEN Open

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We encountered a case of a large hematoma developing with perforation shortly after a cold snare polypectomy for a colorectal adenoma. The patient underwent cold snare polypectomy for a 3‐mm type Is lesion in the transverse colon at another facility. Two hours later, she visited the emergency room due to abdominal pain. Contrast‐enhanced computed tomography revealed a 70 mm, high‐intensity mass in the transverse colon with contrast extravasation. We attempted transcatheter arterial embolization to stop the bleeding. Several hours later, the anemia had not worsened, but the severe abdominal pain persisted. Urgent laparoscopic right hemicolectomy was performed due to the possibility of gastrointestinal perforation. The surgery was successfully completed. Pathology reports confirmed the presence of an intramural hematoma in the proximal transverse colon with hemorrhagic infiltration of all layers, along with extensive ischemic changes. A perforation was identified in this area, with mucosal defects observed near the hole, possibly due to cold snare polypectomy.

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Phlegmonous Colitis after Cold Snare Polypectomy in an Immunosuppressed Patient: A Case Report

Kimura,

Ichita,

Sumida

et al. 2024

Case Rep Gastroenterol

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Introduction: Cold snare polypectomy (CSP) is a procedure with a low risk of complications. Here, we present our experience of a rare case of submucosal abscess following CSP in an immunosuppressed patient. Case Presentation: Seventy-eight-year-old man underwent CSP, developing a fever, chills, and right lower abdominal pain 8 days later. Ultrasound and computed tomography revealed wall thickening of the ascending colon, presenting as whitening and thickening of the same region, and excretion of pus was observed after biopsy. The diagnosis was made as phlegmonous colitis, for which antibiotic therapy was commenced. The patient was diagnosed with chronic myelomonocytic leukemia (CMML) during admission. We considered the following reasons as possible causes of infectious complications after CSP: (1) the patient had a highly immunosuppressed state with comorbidities such as CMML as well as diabetes mellitus and (2) disruption of the mucosal barrier occurred during endoscopic resection. Conclusion: Although CSP is generally considered safe, our case highlights the potential for serious complications in immunosuppressed patients. Therefore, the decision to perform CSP in such patients should be made with caution to avoid unnecessary interventions. In instances where treatment is essential, thorough bowel preparation and prophylactic antibiotic use may be necessary to mitigate the risks.

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Delayed perforation after cold snare polypectomy for small colonic polyps in a patient receiving oral corticosteroids

Cited by 3 publications

References 10 publications

A case of delayed perforation after cold snare polypectomy treated conservatively by endoscopic clip closure

A case of delayed perforation after cold snare polypectomy treated conservatively by endoscopic clip closure

A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon

Phlegmonous Colitis after Cold Snare Polypectomy in an Immunosuppressed Patient: A Case Report

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