BACKGROUND Postpolypectomy syndrome(PPS)is a rare postoperative complication of colonic polypectomy.It presents with abdominal pain and fever accompanied by coagulopathy and elevated inflammatory markers.Its prognosis...BACKGROUND Postpolypectomy syndrome(PPS)is a rare postoperative complication of colonic polypectomy.It presents with abdominal pain and fever accompanied by coagulopathy and elevated inflammatory markers.Its prognosis is usually good,and it only requires outpatient treatment or observation in a general ward.How-ever,it can be life-threatening.CASE SUMMARY The patient was a 58-year-old man who underwent two colonic polypectomies,each resulting in life-threatening sepsis,septic shock,and coagulopathy.Each of the notable manifestations was a rapid drop in blood pressure,an increase in heart rate,loss of consciousness,and heavy sweating,accompanied by shortness of breath and decreased oxygen in the finger pulse.Based on the criteria of organ dysfunction due to infection,we diagnosed him with sepsis.The patient also experienced severe gastrointestinal bleeding after the second operation.Curiously,he did not complain of any abdominal pain throughout the course of the illness.He had significantly elevated concentrations of inflammatory markers and coagulopathy.Except for the absence of abdominal pain,his fever,significant coagulopathy,and elevated inflammatory marker concentrations were all consistent with PPS.Abdominal computed tomography and superior mesenteric artery computed tomography angiography showed no free air or vascular damage.Thus,the diagnosis of colon perforation was not considered.The final blood culture results indicated Moraxella osloensis.The patient was transferred to the intensive care unit and quickly improved after fluid resuscitation,antibiotic treatment,oxygen therapy,and blood transfusion.CONCLUSION PPS may induce dysregulation of the systemic inflammatory response,which can lead to sepsis or septic shock,even in the absence of abdominal pain.展开更多
This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following...This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.展开更多
Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various les...Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various lesions in the lower gastrointestinal tract,including diverticular bleeding,postpolypectomy bleeding,and repair of perforations with successful outcomes.We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.展开更多
基金the Scientific Research Project of the Natural Science Foundation of Changsha,No.kq2202413.
文摘BACKGROUND Postpolypectomy syndrome(PPS)is a rare postoperative complication of colonic polypectomy.It presents with abdominal pain and fever accompanied by coagulopathy and elevated inflammatory markers.Its prognosis is usually good,and it only requires outpatient treatment or observation in a general ward.How-ever,it can be life-threatening.CASE SUMMARY The patient was a 58-year-old man who underwent two colonic polypectomies,each resulting in life-threatening sepsis,septic shock,and coagulopathy.Each of the notable manifestations was a rapid drop in blood pressure,an increase in heart rate,loss of consciousness,and heavy sweating,accompanied by shortness of breath and decreased oxygen in the finger pulse.Based on the criteria of organ dysfunction due to infection,we diagnosed him with sepsis.The patient also experienced severe gastrointestinal bleeding after the second operation.Curiously,he did not complain of any abdominal pain throughout the course of the illness.He had significantly elevated concentrations of inflammatory markers and coagulopathy.Except for the absence of abdominal pain,his fever,significant coagulopathy,and elevated inflammatory marker concentrations were all consistent with PPS.Abdominal computed tomography and superior mesenteric artery computed tomography angiography showed no free air or vascular damage.Thus,the diagnosis of colon perforation was not considered.The final blood culture results indicated Moraxella osloensis.The patient was transferred to the intensive care unit and quickly improved after fluid resuscitation,antibiotic treatment,oxygen therapy,and blood transfusion.CONCLUSION PPS may induce dysregulation of the systemic inflammatory response,which can lead to sepsis or septic shock,even in the absence of abdominal pain.
基金Supported by Faculty of Medicine,Siriraj Hospital,Mahidol University,Bangkok,Thailand
文摘This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.
文摘Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various lesions in the lower gastrointestinal tract,including diverticular bleeding,postpolypectomy bleeding,and repair of perforations with successful outcomes.We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.
