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Z Gastroenterol 2017; 55(10): 1009-1013
DOI: 10.1055/s-0043-108125
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

A case report of delayed intra-abdominal and intra-luminal haemorrhage after polypectomy

Rare complication after colonoscopy and polypectomyVerzögert auftretende intra-abdominelle und intra-luminale Hämorrhagie nach Polypektomie: ein FallberichtSeltene Komplikation nach Koloskopie mit Polypektomie
Albrecht Neesse
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg August University, Goettingen, Germany
,
Marian Grade
2   Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Georg August University, Goettingen, Germany
,
Sebastian Dango
2   Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Georg August University, Goettingen, Germany
,
Michael Ghadimi
2   Department of General, Visceral and Pediatric Surgery, University Medical Center Goettingen, Georg August University, Goettingen, Germany
,
Volker Ellenrieder
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg August University, Goettingen, Germany
,
Steffen Kunsch
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg August University, Goettingen, Germany
,
Ahmad Amanzada
1   Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Georg August University, Goettingen, Germany
› Author Affiliations
Further Information

Publication History

03 March 2017

31 March 2017

Publication Date:
11 October 2017 (online)

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Abstract

We report the case of a 70-year-old man who presented with hematochezia, anaemia, and severe abdominal pain 6 days after polypectomy. Contrast-enhanced ultrasound and computed tomography revealed no signs of free intra-abdominal air but showed intra-abdominal and intra-luminal bleeding. The patient was referred to colonoscopy in the operation room, which showed a coagula and venous bleeding at the polypectomy site. Emergency laparotomy was performed and revealed a large intra-abdominal mesocolic hematoma, which was surgically removed. The patient’s post-operative recovery was uneventful. While few reports of splenic vessel rupture after colonoscopy due to traction on the splenocolic ligament have been published, delayed mesocolic hematoma without evidence of organ damage has not been reported so far. Clinicians need to be aware of these rare but life-threatening complications following colonoscopy.

Zusammenfassung

Wir berichten über einen 70-jährigen Patienten, der sich aufgrund einer neu aufgetretenen Hämatochezie, Anämie und abdominellen Schmerzen sechs Tage nach erfolgter Koloskopie und Polypektomie notfallmäßig vorstellte. Die Kontrastmittelsonografie und die Computertomografie zeigten keine Hinweise auf eine Perforation, jedoch Zeichen eines großen intra-abdominellen Hämatoms. Koloskopisch zeigte sich eine leichte Sickerblutung an der Polypektomiestelle ohne Nachweis einer weiteren intraluminalen Blutung. Die nachfolgend durchgeführte Notfall-Laparotomie wies ein großes intraabdominelles mesokolisches Hämatom nach, welches erfolgreich ausgeräumt werden konnte. Der postoperative Verlauf gestaltete sich komplikationslos. Es existieren einzelne Fallberichte über unmittelbare Milzgefäßverletzungen nach ausgeübter Traktion des splenokolischen Ligaments im Rahmen der Koloskopie, jedoch gibt es bisher keine Berichte über das Auftreten eines verspäteten mesokolischen Hämatoms. Endoskopiker sollten sich dieser seltenen, aber potentiell lebensbedrohlichen Komplikation bewusst sein.

Schlüsselwörter

Gastrointestinale Blutung - Koloskopie - Intrabdominelle Blutung

Key words

gastrointestinal bleeding - colonoscopy - intra-abdominal bleeding
 

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