Advertisement

CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy

  • Y.J. Shin
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, South Korea
    Search for articles by this author
  • Y.H. Kim
    Correspondence
    Guarantor and correspondent: Y. H. Kim, Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, South Korea. Tel.: +82 31 787 7619; fax: +82 31 787 4011.
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, South Korea
    Search for articles by this author
  • K.H. Lee
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, South Korea
    Search for articles by this author
  • Y.J. Lee
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, South Korea
    Search for articles by this author
  • J.H. Park
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, South Korea
    Search for articles by this author
Published:April 13, 2016DOI:https://doi.org/10.1016/j.crad.2016.03.010

      Highlights

      • PPCS shows severe colonic wall thickening with infiltration on CT.
      • The awareness of PPCS avoids unnecessary surgery in post-polypectomy patients.
      • CT can help to choose conservative management in patients with perforation.

      Aim

      To investigate the clinical characteristics and computed tomography (CT) findings of post-polypectomy coagulation syndrome (PPCS) and colonic perforation in patients who have undergone colonoscopic polypectomy.

      Materials and methods

      Through a hospital database search, 5542 adult patients (age >40 years) who had undergone colonoscopic polypectomy from January 2011 to November 2014 were identified. After identification of patients with PPCS and colonic perforation, two abdominal radiologists reviewed the CT images of the patients in consensus.

      Results

      Eight patients (0.14%) with PPCS and six patients (0.11%) with perforation were identified. Five patients were excluded for absence of CT examination, leaving four patients with PPCS and five patients with perforation included in the study. Three of the patients with perforation eventually underwent surgery, while all the patients with PPCS completely recovered with conservative management. On CT images, the involved colonic wall was longer and thicker in the PPCS group than in the perforation group. All four patients with PPCS showed a mural defect filled with fluid and stratified enhancement with surrounding infiltration. Two patients, who did not undergo surgery for perforation, did not show surrounding infiltration and fluid collection.

      Conclusion

      On CT images, PPCS shows severe mural thickening with a stratified enhancement pattern, a mural defect filled with fluid and surrounding infiltration in addition to absence of extraluminal air. In patients with perforation, absence of CT findings suggestive of surrounding inflammation or peritonitis would help in choosing non-surgical management.
      To read this article in full you will need to make a payment
      Subscribe to Clinical Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Winawer S.J.
        • Zauber A.G.
        • O'Brien M.J.
        • et al.
        Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup.
        N Engl J Med. 1993; 328: 901-906
        • Zauber A.G.
        • Winawer S.J.
        • O'Brien M.J.
        • et al.
        Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
        N Engl J Med. 2012; 366: 687-696
        • Fisher D.A.
        • Maple J.T.
        • Ben-Menachem T.
        • et al.
        Complications of colonoscopy.
        Gastrointest Endosc. 2011; 74: 745-752
        • Whitlock E.P.
        • Lin J.S.
        • Liles E.
        • et al.
        Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2008; 149: 638-658
        • Waye J.D.
        • Lewis B.S.
        • Yessayan S.
        Colonoscopy: a prospective report of complications.
        J Clin Gastroenterol. 1992; 15: 347-351
        • Waye J.D.
        • Kahn O.
        • Auerbach M.E.
        Complications of colonoscopy and flexible sigmoidoscopy.
        Gastrointest Endosc Clin N Am. 1996; 6: 343-377
        • Christie J.P.
        • Marrazzo 3rd, J.
        Mini-perforation” of the colon–not all postpolypectomy perforations require laparotomy.
        Dis Colon Rectum. 1991; 34: 132-135
        • Cha J.M.
        • Lim K.S.
        • Lee S.H.
        • et al.
        Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case–control study.
        Endoscopy. 2013; 45: 202-207
        • Benson B.C.
        • Myers J.J.
        • Laczek J.T.
        Postpolypectomy electrocoagulation syndrome: a mimicker of colonic perforation.
        Case Rep Emerg Med. 2013; 2013: 687931https://doi.org/10.1155/2013/687931
        • Ko C.W.
        • Dominitz J.A.
        Complications of colonoscopy: magnitude and management.
        Gastrointest Endosc Clin N Am. 2010; 20: 659-671
        • Ko C.W.
        • Riffle S.
        • Shapiro J.A.
        • et al.
        Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy.
        Gastrointest Endosc. 2007; 65: 648-656
        • Daly B.
        • Lu M.
        • Pickhardt P.J.
        • et al.
        Complications of optical colonoscopy: CT findings.
        Radiol Clin N Am. 2014; 52: 1087-1099
        • Balthazar E.J.
        CT of the gastrointestinal tract: principles and interpretation.
        AJR Am J Roentgenol. 1991; 156: 23-32
        • Wittenberg J.
        • Harisinghani M.G.
        • Jhaveri K.
        • et al.
        Algorithmic approach to ct diagnosis of the abnormal bowel wall 1.
        RadioGraphics. 2002; 22: 1093-1107
        • Hotta K.
        • Shinohara T.
        • Oyama T.
        • et al.
        Criteria for non-surgical treatment of perforation during colorectal endoscopic submucosal dissection.
        Digestion. 2012; 85: 116-120
        • Furukawa A.
        • Sakoda M.
        • Yamasaki M.
        • et al.
        Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause.
        Abdominal Imaging. 2005; 30: 524-534