Bleeding
- Usually associated with polypectomy
- 1-2%
- Immediate
- Endoscopic hemostatic methods
- Repeat colonoscopy
- Delayed
- Typically seen five to seven days after the procedure
Perforation
Incidence < 1/1000. Higher in biopsy, polypectomy and diseased colon (IBD, diverticular)
Mechanisms:
- Mechanical (scope trauma)
- Barotrauma
- Procedural (polypectomy, energy use, dilatation etc.)
- Most common site is sigmoid; caecum/ascending prone to barotrauma.
Presentation:
- Symptoms of distension
- Discomfort
- Peritonitis
- Nausea/vomiting
- Diarrhoea & constipation.
- 50% have delayed presentation.
Management:
- Initial – bowel rest, resuscitation and correction of electrolytes. NG not necessary unless N/V. CXR – free air or CT +/- contrast enema
- Endoscopic – possible in some situations.
- Surgery – required if peritonitis, large defect, clinical deterioration
Sedation
Low risk
Preparation
- Fluid and electrolyte disturbances
- Nausea, vomiting
- Abdominal bloating and abdominal discomfort
- Aspiration
- Esophageal tears from vomiting
Postpolypectomy syndrome
- Electrocoagulation injury to the bowel wall, creating a transmural burn and focal peritonitis without frank perforation.
- Clinical manifestations include pain, fever, focal abdominal tenderness, and leukocytosis one to five days following polypectomy.
- Management includes intravenous hydration, antibiotics, and bowel rest.