Shinban Liu, DO1, Nicholas Morin, DO1, Vadim Meytes, DO2. 1NYU Langone Medical Center, 2Vassar Brothers Medical Center
Case Description: A 78-year-old woman presents to the emergency department with complaints of abdominal pain. Earlier that day she had undergone a routine screening colonoscopy with polypectomy of 3 sessile polyps removed from the transverse colon. She was hemodynamically stable but febrile (101.3?). Laboratory values were significant for white blood cell count of 16.3 K/uL but otherwise grossly within normal limits. A computed tomography of the abdomen and pelvis demonstrated no free intraperitoneal air and focal wall thickening of the mid transverse colon containing biopsy clips. Due to her clinical presentation with localized peritonitis, laboratory workup, and imaging studies the patient was brought urgently to the operating room for diagnostic laparoscopy. Upon insertion of the laparoscope, no perforation or gross spillage was identified after examination of the bowel. The prior polypectomy site in the mid transverse colon was located with identification of colonoscopic tattoo and noted to have surrounding hyperemia and edema consistent with transmural burn without perforation. The remainder of her hospital course was unremarkable and was ultimately discharged home with suspected postpolypectomy electrocoagulation syndrome.
Discussion: Postpolypectomy electrocoagulation syndrome (also known as polypectomy syndrome and transmural burn syndrome) is a rare condition with an incidence of 0.07% following colonoscopic polypectomy. Development of this syndrome is associated with large amounts of thermal energy over extended periods of time when performing extensive endoscopic submucosal dissection. The electrical current is theorized to extend past the targeted mucosa into the muscularis propria and serosa creating a transmural burn without associated perforation. Clinically this may manifest as localized peritonitis secondary to serosal irritation and subsequent inflammatory response. Patients may also present with symptoms of fever, leukocytosis, and imaging demonstrating inflammation with or without microperforation such as in this case– all of which are concerning for an acute surgical abdomen. This diagnosis should be suspected in patients following polypectomy with electrocautery but should be confirmed with imaging to evaluate for frank perforation and free air rather than focal wall thickening and inflammatory changes as seen in this syndrome. Treatment of this syndrome consists of conservative management with nothing by mouth, antibiotics, and intravenous fluids until symptoms improve with the majority of patients fully recovering. Recognition of this condition is important as unnecessary surgery can be avoided.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93400
Program Number: P301
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster