1
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Heo S, Huh J, Kim JK, Lee KM. Delayed Perforation After Endoscopic Resection of Upper Gastrointestinal Tumors: CT Findings to Identify Patients Requiring Surgery. J Clin Gastroenterol 2024:00004836-990000000-00308. [PMID: 38896425 DOI: 10.1097/mcg.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To determine the clinical and imaging factors associated with surgical treatment in patients with delayed perforation after endoscopic resection of upper gastrointestinal tumors. METHODS We retrospectively included patients with delayed perforation after endoscopic tumor resection for gastric or duodenal tumors between January 2007 and December 2021 in a tertiary hospital. We compared the clinical, endoscopic, and CT findings of the surgical and conservative treatment groups. Univariable and multivariable analyses were performed to identify significant factors associated with surgery. RESULTS Among 10,423 patients who had undergone endoscopic tumor resection, 52 (0.50%) experienced delayed perforation, with 20 patients (35.5%) treated surgically and 32 patients (64.5%) treated conservatively. The CT findings of gross perforation (adjusted odds ratio [OR]=6.75, 95% confidence interval [CI], 1.04-43.89; P=0.045) and presence of peritonitis (OR=34.26, 95% CI, 5.52-212.50; P<0.001) were significantly associated with surgical treatment. Other clinical factors as well as CT-measured amount of pneumoperitoneum were not significant factors. CONCLUSIONS CT findings of gross perforation and peritonitis are significant factors associated with surgery in delayed perforation after endoscopic tumor resection. These factors can aid in guiding the patients towards an appropriate treatment plan.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Jimi Huh
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Yeongtong-gu, Suwon
| | - Jai Keun Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Yeongtong-gu, Suwon
| | - Ki Myung Lee
- Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Yeongtong-gu, Suwon, Republic of Korea
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2
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Sanchez KJ, Walsh EC, Bittner EA, Ruscic KJ. A Case Report of Tension Hydrothorax Incited by Bowel Perforation. A A Pract 2023; 17:e01729. [PMID: 38088771 PMCID: PMC10723813 DOI: 10.1213/xaa.0000000000001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
We report the case of a 34-year-old man who developed cardiac arrest due to tension hydrothorax from colonic perforation. Tension hydrothorax, an entity characterized by pleural effusion leading to mediastinal compression, has not been reported in association with intraabdominal inflammation. Our patient developed respiratory insufficiency after repair of colonic perforation, followed by respiratory failure and cardiac arrest. Transthoracic echocardiography provided rapid diagnosis during decompensation and prompted a lifesaving thoracostomy. Clinicians should consider tension hydrothorax as a rare cause of hemodynamic collapse, even in the absence of liver failure, and use bedside tools like transthoracic echocardiography to facilitate diagnosis and intervention.
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Affiliation(s)
- Kyle J Sanchez
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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3
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Sadeghi A, Salarieh N, Ketabi Moghadam P. A step-by-step guide to approaching colon polyps. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2023; 16:347-356. [PMID: 37767319 PMCID: PMC10520385 DOI: 10.22037/ghfbb.v16i2.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/03/2023] [Indexed: 09/29/2023]
Abstract
Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps, and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation (2). Knowing this significance, the present study aims to present a brief review on classification, probability of endoscopic resection, complications of endoscopic polypectomy, as well as proper surveillance after polypectomy.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghmeh Salarieh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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4
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Zachou M, Pikramenos K, Mpetsios G, Lalla E, Panoutsakou M, Varytimiadis K, Karantanos P. Post-polypectomy coagulation syndrome: a tricky to diagnose hot snare problem that can be eliminated thanks to cold snare revolution. Arch Clin Cases 2022; 9:170-172. [PMID: 36628162 PMCID: PMC9769077 DOI: 10.22551/2022.37.0904.10226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Post-polypectomy syndrome or post-polypectomy coagulation syndrome (PPCS) is a rare adverse event of thermal injury caused during hot snare aided, endoscopic mucosal resection of colon polyps. Its diagnosis is tricky as it is commonly misdiagnosed as perforation leading to unnecessary exploratory abdominal surgeries. The authors aim to present an early diagnosed and successfully treated, case of PPCS, and to highlight the difference in the safety profile of two techniques; hot snare versus cold snare polypectomy.
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Affiliation(s)
- Maria Zachou
- Department of Gastroenterology, “Sismanoglio-Amalia Fleming” General Hospital, Athens, Greece,Correspondence: Zachou Maria, Gastroenterology Department, “Sismanoglio-Amalia Fleming” General Hospital, Athens, Sismanogleiou 1, PC 15126, Greece.
| | | | - Georgios Mpetsios
- Department of Gastroenterology, “Sismanoglio-Amalia Fleming” General Hospital, Athens, Greece
| | - Efthimia Lalla
- Department of Gastroenterology, “Sismanoglio-Amalia Fleming” General Hospital, Athens, Greece
| | - Maria Panoutsakou
- Department of Gastroenterology, “Sismanoglio-Amalia Fleming” General Hospital, Athens, Greece
| | | | - Panayiotis Karantanos
- Department of Gastroenterology, “Sismanoglio-Amalia Fleming” General Hospital, Athens, Greece
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5
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Zheng L, Jiang L, Li D, Chen L, Jiang C, Xie L, Zhou L, Huang J, Liu M, Wang W. Antimicrobial prophylaxis in patients undergoing endoscopic mucosal resection for 10- to 20-mm colorectal polyps: A randomized prospective study. Medicine (Baltimore) 2022; 101:e31440. [PMID: 36550912 PMCID: PMC9771180 DOI: 10.1097/md.0000000000031440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Endoscopic mucosal resection (EMR) is frequently used for the removal of colorectal neoplasms. However, the use of prophylactic antibiotics in patients undergoing EMR is debatable. The aim of this randomized controlled trial was to assess whether antimicrobial prophylaxis is crucial in the perioperative period of EMR, especially for 10- to 20-mm lesions in this setting. METHODS Two hundred and sixty-four patients were randomized equally into 2 groups, the antibiotic (cefixime) group and the control group. The occurrence of adverse events was examined at 1 to 3 days after EMR. Plasma levels of inflammatory markers were analyzed at pre-operation, 1 day post-operation and 3 days post-operation. Blood samples collected at 1 day post-operation were used for culture. RESULTS A total of 264 and 268 polyps were removed by EMR in the antibiotic group and the control group, respectively. There were 5 cases of fever, with 2 in the antibiotic group and 3 in the control group. In the antibiotic group, 12 patients had abdominal pain and 10 suffered bleeding, whereas in the control group, abdominal pain and bleeding were observed in 10 and 11 patients, respectively. There were no significant differences in the proportion of patients with fever or the incidences of postoperative complications between the groups. No significant differences between the groups were reported in plasma levels of white blood cell count, erythrocyte sedimentation rate, C-reactive protein or procalcitonin at pre-operation or post-operation. No patients provided positive blood cultures. CONCLUSIONS The use the prophylactic antibiotics for EMR procedures in the perioperative period is no longer required when the lesions are 10 to 20 mm in size.
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Affiliation(s)
- Linfu Zheng
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Liping Jiang
- Meng Chao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Dazhou Li
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Longping Chen
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
| | - Chuanshen Jiang
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
| | - Longke Xie
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Linxin Zhou
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Jianxiao Huang
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Meiyan Liu
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
- *Correspondence: Wen Wang, Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Oriental Hospital Affiliated to Xiamen University, Fuzhou 350025, China (e-mail: )
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6
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Qiu J, Ouyang Q, Zhang Y, Xu J, Xie Y, Wei W, Pan X. Post-endoscopic submucosal dissection electrocoagulation syndrome: a clinical overview. Expert Rev Gastroenterol Hepatol 2022; 16:1079-1087. [PMID: 36503328 DOI: 10.1080/17474124.2022.2156858] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is a rare complication following endoscopic submucosal dissection (ESD). However, many aspects of PEECS are still controversial and there is a lack of up-to-date review. The aim of this article is to provide a comprehensive review on PEECS. AREAS COVERED The English-language literature was searched for articles on PEECS, with a focus on its pathogenesis, definition, and diagnosis, incidence rate, risk factors, prevention, management, and prognosis. EXPERT OPINION Many aspects of PEECS are still controversial such as etiology, diagnostic criteria, prevention and management. The recent studies tend to agree on the diagnostic criteria for PEECS, defined as localized abdominal tenderness and fever or inflammatory response without delayed perforation. Most patients with PEECS have a favorable prognosis with conservative treatment and more high-quality studies are needed in the controversial aspects mentioned above.
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Affiliation(s)
- Jiayu Qiu
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingping Ouyang
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yanxia Zhang
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Xu
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yingping Xie
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenjun Wei
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaolin Pan
- Digestive Disease Hospital, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.,Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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7
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Moon JY, Lee MR, Yim SK, Ha GW. Colo-colonic intussusception with post-polypectomy electrocoagulation syndrome: A case report. World J Clin Cases 2022; 10:8939-8944. [PMID: 36157670 PMCID: PMC9477040 DOI: 10.12998/wjcc.v10.i25.8939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Post-polypectomy electrocoagulation syndrome (PPES) can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis. Nevertheless, there can be cases with complications developing.
CASE SUMMARY A 58-year-old woman, who had no previous medical history, visited the Emergency Department of another hospital with symptoms of abdominal pain and fever, 1 d after multiple colonoscopic polypectomies. An abdominopelvic computed tomography (CT) scan demonstrated colo-colonic intussusception, and she was transferred to our hospital to consider an operation. CT showed colo-colonic intussusception with PPES and no evidence of obstruction. The physical examination showed localized mild tenderness on the right sided abdomen. The patient fasted and was admitted for treatment with intravenous antibiotics (piperacillin/tazobactam 4.5 g each 8 h, ornidazole 500 mg each 12 h). After admission, the symptoms got better and a follow-up CT scan demonstrated resolution of the PPES and intussusception. The patient was discharged on hospital day 9.
CONCLUSION Colo-colic intussusception can occur with PPES, and it can be properly treated conservatively.
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Affiliation(s)
- Jae Young Moon
- Department of Surgery, Jeonbuk National University Hospital, Jeonju 561-180, Jeonbuk, South Korea
| | - Min-Ro Lee
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 561-180, Jeonbuk, South Korea
| | - Sung Kyun Yim
- Department of Internal Medicine, Biomedical Research Institute, Jeonbuk National University Hospital and Medical School, Jeonju 54907, Jeonbuk, South Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 561-180, Jeonbuk, South Korea
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8
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Romo JA, Peña JD, López LA, Figueroa C, Garzon H, Recamán A. Post-polypectomy syndrome—a rare complication in colonoscopy procedures: a case report. J Surg Case Rep 2022; 2022:rjac369. [PMID: 36051004 PMCID: PMC9427180 DOI: 10.1093/jscr/rjac369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Post-polypectomy syndrome (PPS) is a complication that may arise after some colonoscopy procedures that require electrocoagulation, due to a transmural burn, which irritates the serous membrane. Its clinical presentation is similar to the one of intestinal perforation, but it has a favorable prognosis, and does not require surgical treatment. We report the case of a 55-year-old woman diagnosed with a polyp in the ascending colon, who was admitted for an endoscopic resection. After the procedure, she complained of nausea, emesis and abdominal pain in the right iliac fossa. She was transferred to the emergency department. An abdominal tomography showed cecal wall thickening without pneumoperitoneum. Therefore, the diagnosis of PPS was made and was managed with bowel rest, parenteral fluids and antibiotics, with full recovery. Despite of its low incidence, it is important to suspect this syndrome to avoid unnecessary surgical treatment and initiate medical management right away.
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Affiliation(s)
- Julián A Romo
- School of Medicine, Universidad del Rosario , Bogota D.C. , Colombia
| | - Jorge David Peña
- School of Medicine, Universidad del Rosario , Bogota D.C. , Colombia
| | - Laura A López
- School of Medicine, Universidad del Rosario , Bogota D.C. , Colombia
| | - Carlos Figueroa
- Department of Coloproctology, Hospital Universitario Mayor Méderi , Bogota D.C. , Colombia
| | - Horacio Garzon
- Department of Coloproctology, Hospital Universitario Mayor Méderi , Bogota D.C. , Colombia
| | - Andrea Recamán
- School of Medicine, Universidad del Rosario, Bogota D.C., Colombia
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9
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Jing W, Qinghua L, Zhiwen Y. Postpolypectomy fever in patients with serious infection: a report of two cases. BMC Gastroenterol 2022; 22:156. [PMID: 35350984 PMCID: PMC8966367 DOI: 10.1186/s12876-022-02218-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Postpolypectomy fever (PPF) is a rare complication in patients after colonoscopy. Because of the absence of evidence of microperforation and abdominal tenderness, patients with PPF usually present mild clinical symptoms with a good prognosis. Case presentation In this study, all patients who underwent colonoscopic examination in our hospital between January 2019 and December 2019 were enrolled. Of these, two patients developed PPF after polypectomy, exhibiting serious infection without definitive fever foci. One patient experienced rapidly aggravated type 1 respiratory failure and abnormal hepatic function, which were attributed to colonoscopy-associated infection. After active antibiotic therapy, both patients were discharged without any complications. Conclusions In summary, our study provides novel insights into patients with PPF who develop serious infections with life-threatening complications.
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Affiliation(s)
- Wang Jing
- Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China
| | - Li Qinghua
- Department of Gastroenterology, Songjiang District Central Hospital, Shanghai, China
| | - Yang Zhiwen
- Department of Pharmacy, Songjiang District Central Hospital, Shanghai, 201600, China.
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10
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Boster JM, Iwanowski M, Kramer RE. Management of Pediatric Postendoscopy Fever: Reducing Unnecessary Health Care Utilization With a Clinical Care Guideline. J Pediatr Gastroenterol Nutr 2021; 72:250-254. [PMID: 32925556 PMCID: PMC8256551 DOI: 10.1097/mpg.0000000000002936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aim of the study was to validate rates of fever after pediatric gastrointestinal endoscopy, to describe clinical outcomes of postendoscopy fever (PEF) cases, and to assess the effect of a PEF clinical care guideline (CCG) on hospital use. PATIENTS AND METHODS Episodes of PEF were reviewed from a large prospective database of all adverse events following pediatric gastrointestinal endoscopy at an academic children's hospital. A CCG was implemented to standardize care of children with reported fever after endoscopy and reduce unnecessary resource use. Chi-squared analysis was performed to compare rates of hospital use for evaluation of PEF before and after implementation of the CCG. RESULTS PEF occurred in 0.55% of the 27,100 endoscopies performed during the present study period. In the 150 cases of reported fever, the rate of identified endoscopy-related infection was low (4.0%). The rate of PEF was significantly higher in patients who underwent interventional procedures (0.81%) than those who underwent diagnostic endoscopy (0.51%, P = 0.02). In patients who experienced PEF, the CCG significantly reduced hospital use, decreasing emergency department visits and hospital admissions by 52.1% (P < 0.0001) without leading to negative patient outcomes. CONCLUSION PEF in children rarely represents clinically significant infection and may be due in part to inflammation from tissue damage and/or physiologic stress. The present study shows that implementation of a PEF CCG may reduce unnecessary care while maintaining patient safety. Furthermore, multicenter studies are required to confirm the overall safety of similar clinical algorithms.
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Affiliation(s)
- Julia M. Boster
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Digestive Health Institute, Aurora, CO
| | - Melissa Iwanowski
- Quality and Patient Safety, Children’s Hospital Colorado, Aurora, CO
| | - Robert E. Kramer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Digestive Health Institute, Aurora, CO
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11
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Matz D, Heizmann O. Necrotizing Fasciitis of The Abdominal Wall Following Colonoscopy with Fatal Outcome - A Case Report. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.05.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Necrotizing fasciitis (NF) is a serious and potentially life threatening soft tissue infection, usually caused by different types of bacteria such as group A streptococcus, staphylococcus spp. (type 1 infection) or mixed infection by aerobic and anaerobic bacteria (type 2 infection). Usually, the infection arises from skin injury, in injections or surgical procedures and effects the fascia as well as the subcutaneous tissue. Overwhelming progression and difficulties in diagnosing are very common. Mortality rate is up to 100% depending on the type of soft tissue infection and did not markedly decrease in the past decades [1]. Here we present a case of NF with fatal outcome following colonoscopy, which was primarily suspected to be a post polypectomy syndrome.
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12
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Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS, Ki HK. A randomized controlled trial of prophylactic antibiotics in the prevention of electrocoagulation syndrome after colorectal endoscopic submucosal dissection. Gastrointest Endosc 2017; 86:349-357.e2. [PMID: 27899322 DOI: 10.1016/j.gie.2016.11.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is currently commonly performed, but colorectal ESD has a substantial risk of adverse events, including post-ESD electrocoagulation syndrome (PEECS). We investigated whether the use of prophylactic antibiotics can reduce the occurrence of PEECS. METHODS Patients who underwent colorectal ESD were randomly assigned to 1 of 2 treatment regimens. Ampicillin and/or sulbactam mixed with normal saline solution was administered 1 hour before ESD in group 1 then additionally injected every 8 hours twice more. In group 2, normal saline solution without antibiotics was administered following the same schedule. We investigated the characteristics of the patients and tumors, the incidence of PEECS, laboratory findings, and the visual analog scale (VAS) score for abdominal pain measured on the morning after ESD. RESULTS A total of 100 cases (50 per group) were finally analyzed, and 97 tumors were successfully resected en bloc. The number of patients having C-reactive protein (CRP) levels ≥1 mg/dL and the number of patients having VAS scores for abdominal pain ≥1 were greater in group 2 than in group 1 (P = .008 and .023, respectively). The incidence of PEECS in group 2 also was higher than that in group 1 (1 and 8 in groups 1 and 2, respectively; P = .031). CONCLUSIONS The prophylactic use of ampicillin and/or sulbactam in colorectal ESD is associated with reduced risk of PEECS, decreased CRP levels, and decreased abdominal pain. The use of prophylactic antibiotics in colorectal ESD may be an effective tool for reducing the risk of PEECS. (Clinical trial registration number: KCT0001102.).
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Chan Sup Shim
- Department of Internal Medicine, Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Kyun Ki
- Division of Infectious Diseases, Konkuk University School of Medicine, Seoul, Korea
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13
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Jehangir A, Bennett KM, Rettew AC, Fadahunsi O, Shaikh B, Donato A. Post-polypectomy electrocoagulation syndrome: a rare cause of acute abdominal pain. J Community Hosp Intern Med Perspect 2015; 5:29147. [PMID: 26486121 PMCID: PMC4612487 DOI: 10.3402/jchimp.v5.29147] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023] Open
Abstract
While generally safe, the most feared complication of colonoscopy is perforation of the colon, occurring in nearly 1 in 1,000 procedures, and is more common when polypectomy is performed and electrocautery is used. Less commonly known is the post-polypectomy electrocoagulation syndrome, a transmural burn of the colon which mimics the signs and symptoms of perforation as well as the time course, but follows a benign course and can be treated conservatively.
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Affiliation(s)
- Asad Jehangir
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA;
| | - Kyle M Bennett
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Andrew C Rettew
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Opeyemi Fadahunsi
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Bilal Shaikh
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
| | - Anthony Donato
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
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14
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Abstract
The 2 most significant complications of colonoscopy with polypectomy are bleeding and perforation. Incidence rates for bleeding (0.1%-0.6%) and perforation (0.7%-0.9%) are generally low. Recognition of pertinent risk factors helps to prevent these complications, which can be grouped into patient-related, polyp-related, and technique/device-related factors. Endoscopists should be equipped to manage bleeding and perforation. Currently available devices and techniques are reviewed to achieve hemostasis and close colon perforations.
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Affiliation(s)
- Selvi Thirumurthi
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1466, Houston, TX 77030, USA
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1466, Houston, TX 77030, USA.
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