Unusual Causes of Abdominal Pain after Colonoscopy: A Case Series

Abstract

Colonoscopy is a relatively safe procedure with an overall complication rate between 0.2 and 0.35%. Complications do occur, however, including preparation related complications, colonic perforation, postpolypectomy hemorrhage, postpolypectomy coagulation syndrome, and other less-common miscellaneous complications. Abdominal pain is one of the more common complaints that symptomatic patients will present with after a colonoscopy, occurring up to 5% of the time. Although the cause is usually minor and does not require further workup, gastroenterologists are most concerned about perforation and postpolypectomy coagulation syndrome in the setting of severe abdominal pain. However, as gastroenterologists, we must also be cognizant that there may be other less-common causes of the abdominal pain. The four cases presented here illustrate rare presentations of abdominal pain after colonoscopy, consisting of acute diverticulitis, incarcerated umbilical hernia, acute gangrenous cholecystitis, and rupture of the ovarian cyst.

Keywords

acute diverticulitis - acute gangrenous cholecystitis - colonoscopy - incarcerated umbilical hernia - rupture of ovarian cyst

• References

• 1 Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976; 235 (09) 928-930
• 2 Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 2002; 55 (03) 307-314
• 3 Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000; 343 (03) 162-168
• 4 Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000; 343 (03) 169-174
• 5 Dominitz JA, Eisen GM, Baron TH. et al. Standards of Practice Committee. American Society for Gastrointestinal Endoscopy. Complications of colonoscopy. Gastrointest Endosc 2003; 57 (04) 441-445
• 6 Zubarik R, Fleischer DE, Mastropietro C. et al. Prospective analysis of complications 30 days after outpatient colonoscopy. Gastrointest Endosc 1999; 50 (03) 322-328
• 7 Ko CW, Riffle S, Michaels L. et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol 2010; 8 (02) 166-173
• 8 Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med 2007; 357 (20) 2057-2066
• 9 Beetham M, Khan MI. Incarceration of an umbilical hernia following colonoscopy. N Z Med J 2009; 122 (1307) 97-99
• 10 Milman PJ, Goldenberg SP. Colonoscopy cholecystitis. Am J Gastroenterol 2001; 96 (05) 1666
• 11 Fernández-Martínez C, Plá-Martí V, Flors-Alandí C, Roig-Vila JV. Gangrenous cholecystitis after colonoscopy. Am J Gastroenterol 2002; 97 (06) 1572
• 12 Aziz F, Milman P, McNelis J. Abdominal pain after colonoscopy: can it be acute cholecystitis?. Dig Dis Sci 2007; 52 (10) 2660-2661
• 13 Maddur H, Agrawal S, Fayad N, Chalasani N, Kahi C. Acute cholecystitis after colonoscopy: a case series. Gastrointest Endosc 2011; 74 (01) 211-213
• 14 Roslyn JJ, DenBesten L, Thompson Jr JE. Silverman BF. Roles of lithogenic bile and cystic duct occlusion in the pathogenesis of acute cholecystitis. Am J Surg 1980; 140 (01) 126-130
• 15 El Ramli R, Koulaouzidis A, Godfrey H, Gasem J. Rupture of a big ovarian cyst and pneumoperitoneum post-colonoscopy and endoscopic mucosal resection. Arab J Gastroenterol 2011; 12 (03) 154-155