Abdominal pain post endoscopic mucosal resection: Treat the patient not the CT scan

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.