Post procedural colonoscopy complications

Question 1

if pt presents post colonoscopy with abdominal pain, nausea, and temperature and had biopsies on colonoscopy, what to consider?

Answer 1

perforation at the polypectomy site.
Perforation can occur at direct mechanical trauma from colonoscope, barotrauma from colonscopy pressure or electrocautery injury during polypectomy. Screening colonoscopy has <0.1% for fperforation but interventions like dilation can increase rate up to 18%.

Question 2

perforations presentation

Answer 2

abdominal pain, distention, and can have fever or chest wall or scapular pain. May see peritoneal signs (rebound tenderness, decreased bowel sounds, abdominal wall rigidity)

Question 3

what imaging should be done for suspected bowel perforation?

Answer 3

abdominal XR plain and upright or lateral decubitus

and upright CXR to look for free air

Question 4

if negative XR and high clinical suspicion for bowel perforation what imaging study to order?

Answer 4

CT scan with water soluble contrast (gastrografin) and CT scan with contrast is far more sensitive that plain films for detecting extraluminal air and subtle perforation

Question 5

management of bowel perforation

Answer 5

needs broad spectrum antibiotics and surgical consultation

Question 6

do we ever use non contrast CT abd scans for looking for suspected bowel perforation?

Answer 6

no, it can miss subtle perforations.