Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case

Boenicke, Lars; Maier, M.; Merger, Michael; Bauer, Meike Sarah; Buchberger, C.; Schmidt, C. Max; Thiede, A; Gassel, H.‐J.

doi:10.1007/s00423-005-0019-z

Cited by 12 publications

(14 citation statements)

References 7 publications

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“…This study identified that pancreatic, small bowel, and splenic surgeries were associated with higher risks among patients aged 18-44, 45-64, and ≥65 years, respectively. In addition, there is much evidence claiming that postoperative sepsis was found in patients after an uncomplicated colonoscopic polypectomy, which is regarded as a safe procedure, due to unidentified abdominal infections [24,25]. These results suggest that general abdominal procedures, including not only complex surgeries but also routine procedures, pose a significant risk for the development of postoperative sepsis.…”

Section: Table 1 Continued: Basic Characteristics Of the Study Particmentioning

confidence: 99%

Epidemiological characteristics of postoperative sepsis

Chen

Luo

Chen³

et al. 2019

Open Medicine

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AbstractBackgroundPostoperative sepsis is a major type of sepsis. Sociodemographic characteristics, incidence trends, surgical procedures, comorbidities, and organ system dysfunctions related to the disease burden of postoperative sepsis episodes are unclear.MethodsWe analyzed epidemiological characteristics of postoperative sepsis based on the ICD-9-CM codes for the years 2002 to 2013 using the Longitudinal Health Insurance Databases of Taiwan’s National Health Insurance Research Database.ResultsWe identified 5,221 patients with postoperative sepsis and 338,279 patients without postoperative sepsis. The incidence of postoperative sepsis increased annually with a crude mean of 0.06% for patients aged 45–64 and 0.34% over 65 years. Patients with postoperative sepsis indicated a high risk associated with the characteristics, male sex (OR:1.375), aged 45–64 or ≥ 65 years (OR:2.639 and 5.862), low income (OR:1.390), aged township (OR:1.269), agricultural town (OR:1.266), and remote township (OR:1.205). Splenic surgery (OR:7.723), Chronic renal disease (OR:1.733), cardiovascular dysfunction (OR:2.441), and organ system dysfunctions had the highest risk of postoperative sepsis.ConclusionRisk of postoperative sepsis was highest among men, older, and low income. Patients with splenic surgery, chronic renal comorbidity, and cardiovascular system dysfunction exhibited the highest risk for postoperative sepsis. The evaluation of high-risk factors assists in reducing the disease burden.

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Section: Table 1 Continued: Basic Characteristics Of the Study Particmentioning

confidence: 99%

Epidemiological characteristics of postoperative sepsis

Chen

Luo

Chen³

et al. 2019

Open Medicine

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“…Iatrogenic Clostridium infection is a rare but documented complication after colonoscopy. In the limited literature surrounding this condition, it has been almost universally fatal, even with aggressive surgical management [7][8][9]. Colonic gas gangrene is a highly fatal infection, with Clostridium toxin production leading to rapid haemodynamic collapse and a rapidly expanding margin of bowel necrosis that can move up to 2 cm per hour [4].…”

Section: Discussionmentioning

confidence: 99%

“…[4] Whilst it is a rare complication in the setting of colonoscopy, it can be rapidly fatal as a result of perforation or septicaemia [5,6]. A literature review identified only 3 cases of abdominal gas gangrene following colonoscopy, all of which were treated surgically and were universally fatal [7][8][9]. Below we describe a case of colonic gas gangrene occurring shortly after colonoscopy in which the patient survived with non-surgical management with excellent recovery.…”

Section: Introductionmentioning

confidence: 98%

A case report of iatrogenic gas gangrene post colonoscopy successfully treated with conservative management- is surgery always necessary?

2020

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Background: Colonoscopy is a routine procedure in diagnosis and treatment of colonic disease. While generally regarded as a safe procedure, potentially fatal complications can occur. Gas gangrene is one such complication, with very high mortality. There are few cases of gas gangrene occurring after colonoscopy, making it one of the rarer complications of this procedure. There have been no previously reported cases of a patient surviving such an infection and the optimal treatment strategy is contentious. This report describes a case of intramural gas gangrene of the colon, treated conservatively with antibiotic therapy in which the patient survived with full recovery. Case presentation: A 71-year-old, previously healthy male presented 6 h post apparently uncomplicated colonoscopic polypectomy with rigors, nausea, vomiting and right upper quadrant pain. At presentation he was febrile at 40.1°C but hemodynamically stable. Abdominal computed tomography revealed substantial colonic thickening and several focal intramural gas bubbles (pneumatosis intestinalis) surrounding the polypectomy site. Within 24 h post procedure he became hypotensive and was admitted to ICU in frank septic shock requiring inotropes, and with demonstrable septic myocardial depression. Bloods showed multi-organ derangement with leukocytosis, lactic acidosis, haemolytic anaemia and hyperbilirubinemia. A diagnosis of presumed Clostridial gas gangrene was made, and treatment was initiated with benzylpenicillin, clindamycin, metronidazole and vancomycin. After 4 days in ICU he was stepped down, and discharged after a further 10 days with no surgical or endoscopic interventions. At three-month review he reported being back to full health.

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“…Two case reports on patients with retroperitoneal gas gangrene after a colonoscopic polypectomy without bowel perforation have been reported [ 13 14 ]. The clinical symptoms and CT findings were similar to those in our case.…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis Following Colonoscopy: A Case Report

Jeong

Kim

et al. 2018

Ann Coloproctol

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We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.

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Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case

Abstract: We conclude that clostridial myonecrosis should be considered in unclear abdominal infections, even if the patient's history is not typical as in the present case.

Cited by 12 publications

References 7 publications

Epidemiological characteristics of postoperative sepsis

Epidemiological characteristics of postoperative sepsis

A case report of iatrogenic gas gangrene post colonoscopy successfully treated with conservative management- is surgery always necessary?

Rhabdomyolysis Following Colonoscopy: A Case Report

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