Reply to Lu H

We express our gratitude to Dr. Lu for his keen interest and comments on our recent publication titled “Endoscopic treatment for a hematoma-mediated colon obstruction caused by acupuncture: A rare case report” [11]. In this response, we will provide a more comprehensive description of the aforementioned case.

The patient had no history of usage of anticoagulant or antiplatelet medication and showed no evidence of prior abdominal trauma or inflammatory bowel diseases. Pertinent laboratory test results were as follows: platelet count 346×10³ /µL; prothrombin time 13.8s; activated partial thromboplastin time 34s; thrombin time 16.3s; international normalized ratio (INR) 1.2.

This is not the first instance of acupuncture-induced intra-abdominal organ injury being documented in the literature [22]. In a previous report, two patients presented with pneumoperitoneum and panperitonitis due to bowel perforation following acupuncture [33]. One patient underwent total colectomy, and the other patient was transferred for surgery elsewhere [33]. Abdominal acupuncture lacks the real-time localization capabilities that exist with EUS-guided fine-needle puncture [44]. In our case report, we were unable to determine the depth, speed, direction, and angle of the needles used on the patient. Therefore, it is not possible to definitively conclude that the needles did not come into contact with the bowel or dismiss the possibility of abdominal acupuncture leading to potential adverse outcomes such as intestinal wall hematomas. Our case report underscores the potential for endoscopic intervention in cases where intestinal wall hematomas arise as a result of this unfavorable outcome.

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 DOI: 10.1055/a-2078-0392. (PMID: 37164331)
• 2 Matsuyama H, Nagao K, Yamakawa GI. et al. Retroperitoneal hematoma due to rupture of a pseudoaneurysm caused by acupuncture therapy. J Urol 1998; 159: 2087-2088 DOI: 10.1016/s0022-5347(01)63262-2. (PMID: 9598531)
• 3 Lee HJ, Kim YJ, Kim WY. Safety Concerns with thoracoabdominal acupuncture: experience at a tertiary-care emergency department. Pain Med 2017; 18: 2504-2508 DOI: 10.1093/pm/pnx068.
• 4 Matsunami Y, Itoi T, Tsuchiya T. et al. Objective evaluation of the resistance forces of 22-gauge EUS-FNA and fine-needle biopsy needles. Endosc Ultrasound 2023; 12: 251-258 DOI: 10.4103/eus-d-22-00059. (PMID: 37148137)