Colonoscopy complications: Difference between revisions
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==Background== | <languages/> | ||
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==Background== <!--T:1--> | |||
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*Over 85% of the serious colonoscopy complications are reported in patients undergoing colonoscopy with polypectomy (7-fold increase)<ref>Complications of colonoscopy. GASTROINTESTINAL ENDOSCOPY Volume 74, No. 4 : 2011</ref> | *Over 85% of the serious colonoscopy complications are reported in patients undergoing colonoscopy with polypectomy (7-fold increase)<ref>Complications of colonoscopy. GASTROINTESTINAL ENDOSCOPY Volume 74, No. 4 : 2011</ref> | ||
==Clinical Features== | |||
==Clinical Features== <!--T:3--> | |||
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*Hemorrhage | *Hemorrhage | ||
**Most common complication | **Most common complication | ||
**Caused by polypectomy, biopsy, mucosal lacerations, mesenteric or splenic tears | **Caused by polypectomy, biopsy, mucosal lacerations, mesenteric or splenic tears | ||
**[[Rectal bleeding]] (if intraluminal) | **[[Special:MyLanguage/Rectal bleeding|Rectal bleeding]] (if intraluminal) | ||
**Intra-abdominal bleed (if mesenteric or [[splenic trauma]]) | **Intra-abdominal bleed (if mesenteric or [[Special:MyLanguage/splenic trauma|splenic trauma]]) | ||
*Perforation | *Perforation | ||
*Post-polypectomy electrocoagulation syndrome | *Post-polypectomy electrocoagulation syndrome | ||
**peritoneal inflammation without frank perforation | **peritoneal inflammation without frank perforation | ||
**[[abdominal pain]], [[fever]], [[leukocytosis]] | **[[Special:MyLanguage/abdominal pain|abdominal pain]], [[Special:MyLanguage/fever|fever]], [[Special:MyLanguage/leukocytosis|leukocytosis]] | ||
*[[Infection]]: [[bacteremia]], retroperitoneal abscess, [[appendicitis]] | *[[Special:MyLanguage/Infection|Infection]]: [[Special:MyLanguage/bacteremia|bacteremia]], retroperitoneal abscess, [[Special:MyLanguage/appendicitis|appendicitis]] | ||
*Colonic distension, precipitation of [[toxic megacolon]] | *Colonic distension, precipitation of [[Special:MyLanguage/toxic megacolon|toxic megacolon]] | ||
*[[Myocardial infarction]], [[PE]] (if off anticoagulation) | *[[Special:MyLanguage/Myocardial infarction|Myocardial infarction]], [[Special:MyLanguage/PE|PE]] (if off anticoagulation) | ||
*Gas explosion | *Gas explosion | ||
**methane (in flatus) + electrocautery → BOOM! | **methane (in flatus) + electrocautery → BOOM! | ||
==Differential Diagnosis== | |||
==Differential Diagnosis== <!--T:5--> | |||
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{{Lower GI bleeding DDX}} | {{Lower GI bleeding DDX}} | ||
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{{Abdominal Pain DDX Diffuse}} | {{Abdominal Pain DDX Diffuse}} | ||
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==Evaluation== <!--T:6--> | |||
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*CBC | *CBC | ||
*Coags, T&S if bleeding | *Coags, T&S if bleeding | ||
*[[CXR]] for free air if concern for perforation | *[[Special:MyLanguage/CXR|CXR]] for free air if concern for perforation | ||
*CT abdomen/pelvis (if presentation concerning for intra-abdominal bleed, infection, or perforation) | *CT abdomen/pelvis (if presentation concerning for intra-abdominal bleed, infection, or perforation) | ||
==Management== | |||
*[[PRBC]] transfusion, reverse coagulopathy if significant bleed | ==Management== <!--T:8--> | ||
*Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or [[abscess]] | |||
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*[[Special:MyLanguage/PRBC|PRBC]] transfusion, reverse coagulopathy if significant bleed | |||
*Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or [[Special:MyLanguage/abscess|abscess]] | |||
*Antibiotics if concern for perforation or infection | *Antibiotics if concern for perforation or infection | ||
**See [[peritonitis]] | **See [[Special:MyLanguage/peritonitis|peritonitis]] | ||
==Disposition== <!--T:10--> | |||
==See Also== <!--T:11--> | |||
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*[[Special:MyLanguage/Post-surgical complications|Post-surgical complications]] | |||
== | ==External Links== <!--T:13--> | ||
== | ==References== <!--T:14--> | ||
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<references/> | <references/> | ||
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[[Category:Surgery]] [[Category:GI]] | [[Category:Surgery]] [[Category:GI]] | ||
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Latest revision as of 12:34, 7 January 2026
Background
- Over 85% of the serious colonoscopy complications are reported in patients undergoing colonoscopy with polypectomy (7-fold increase)[1]
Clinical Features
- Hemorrhage
- Most common complication
- Caused by polypectomy, biopsy, mucosal lacerations, mesenteric or splenic tears
- Rectal bleeding (if intraluminal)
- Intra-abdominal bleed (if mesenteric or splenic trauma)
- Perforation
- Post-polypectomy electrocoagulation syndrome
- peritoneal inflammation without frank perforation
- abdominal pain, fever, leukocytosis
- Infection: bacteremia, retroperitoneal abscess, appendicitis
- Colonic distension, precipitation of toxic megacolon
- Myocardial infarction, PE (if off anticoagulation)
- Gas explosion
- methane (in flatus) + electrocautery → BOOM!
Differential Diagnosis
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Evaluation
- CBC
- Coags, T&S if bleeding
- CXR for free air if concern for perforation
- CT abdomen/pelvis (if presentation concerning for intra-abdominal bleed, infection, or perforation)
Management
- PRBC transfusion, reverse coagulopathy if significant bleed
- Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or abscess
- Antibiotics if concern for perforation or infection
- See peritonitis
Disposition
See Also
External Links
References
- ↑ Complications of colonoscopy. GASTROINTESTINAL ENDOSCOPY Volume 74, No. 4 : 2011