Colonoscopy complications: Difference between revisions
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==Background== | ==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 | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:5--> | ||
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==Evaluation== | ==Evaluation== <!--T:6--> | ||
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*CBC | *CBC | ||
*Coags, T&S if bleeding | *Coags, T&S if bleeding | ||
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==Management== | ==Management== <!--T:8--> | ||
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*[[Special:MyLanguage/PRBC|PRBC]] transfusion, reverse coagulopathy if significant bleed | *[[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]] | *Surgery (or IR) consult for possible laparotomy if concern for intra-abdominal bleed, perforation, or [[Special:MyLanguage/abscess|abscess]] | ||
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==Disposition== | ==Disposition== <!--T:10--> | ||
==See Also== | ==See Also== <!--T:11--> | ||
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*[[Special:MyLanguage/Post-surgical complications|Post-surgical complications]] | *[[Special:MyLanguage/Post-surgical complications|Post-surgical complications]] | ||
==External Links== | ==External Links== <!--T:13--> | ||
==References== | ==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