Colonoscopy complications

Background

• Over 85% of the serious colonoscopy complications are reported in patients undergoing colonoscopy with polypectomy (7-fold increase)

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
  • Diverticulosis
  • Diverticulitis
• Vascular ectasia / angiodysplasia
• Inflammatory bowel disease
• Infectious colitis
• Mesenteric Ischemia / ischemic colitis
• Meckel's diverticulum
• Colorectal cancer / polyps
• Hemorrhoids
  • Internal hemorrhoid
  • External hemorrhoid
• 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
  • Aortocaval fistula
• Acute gastroenteritis
• Aortoenteric fisulta
• Appendicitis (early)
• Bowel obstruction
  • Large bowel obstruction
    • Ogilvie's syndrome
  • Small bowel obstruction
  • Malignant bowel obstruction
• Bowel perforation
• Diabetic ketoacidosis
• Gastroparesis
• Hernia
• Hypercalcemia
• Inflammatory bowel disease
• Mesenteric ischemia
  • Mesenteric vein thrombosis
• 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

See Also

• Post-surgical complications