Acupuncture as the cause of a hematoma-mediated colon obstruction treated endoscopically

I read with great interest the article by Prof. Li et al. [11]. This sounded a warning against acupuncture manipulation, and therefore, I am particularly concerned about this case.

Judging from the text, figures, and video, it was found that an intramural hematoma had been caused by abdominal acupuncture. This had led to a complete obstruction of the lumen in the transverse colon, as shown by computed tomography (Fig. 1 in the article) and by colonoscopy [11]. Firstly, chronic enteral-intramural hematoma is quite rare and tends to occur in patients with hemophilia or receiving anticoagulant therapy [22], whereas abdominal trauma from a penetrating injury such as acupuncture usually causes acute colonic-intramural hematoma. Secondly, the diameter of the acupuncture needle is small (approximately 0.25 mm), and even if deep acupuncture penetrates through the intestinal wall, the intestinal tube will retract after removal of the filiform needle because of the elasticity of the intestinal wall; thus serious intramural hematoma is avoided [33]. Hence, needles can hardly touch the intestines, unless the intestinal peristalsis is diminished, as is caused by some inflammatory bowel diseases [44].

I believe that this acupuncture event would interest many acupuncturists. Therefore, I sincerely hope that Prof. Li might provide any details regarding coagulation and mucosal inflammation in this patient, in order to explore other possible etiologies. It should also be highlighted that for safe abdominal acupuncture, penetration of the peritoneum must be slow.

Publication History

Article published online:
29 May 2024

• References

• 1 Li S, Sun S, Wang G. Endoscopic treatment for a hematoma-mediated colon obstruction caused by acupuncture: A rare case report. Endoscopy 2023; 55: E713-E714
• 2 Abdel Samie A, Theilmann L. Risk factors and management of anticoagulant- induced intramural hematoma of the gastrointestinal tract. Eur J Trauma Emerg Surg 2013; 39: 191-194
• 3 Duan JX, Liu ZS. Review on the safety of deep acupuncture at Tianshu (ST25). Zhen Ci Yan Jiu 2010; 35: 232-235
• 4 Jauregui-Amezaga A, Rimola J. Role of intestinal ultrasound in the management of patients with inflammatory bowel disease. Life (Basel) 2021; 11: 603