title: Abdominal pain post endoscopic mucosal resection: Treat the patient not the CT scan.
abstract: An 85-year-old female, with hereditary nonpolyposis colorectal cancer syndrome, underwent a colonoscopy and endoscopic mucosal resection (EMR) of a 25-mm proximal ascending colon polyp (Paris classification 0-Is). Post-procedure, the patient developed abdominal pain in the right iliac fossa which settled 1 h later. An urgent computed tomography (CT) scan of her abdomen was organised which happened 6 h post onset of abdominal pain. She had radiological evidence of perforation on the CT scan but clinically remained well and was managed conservatively. The exact aetiology of this patient's symptoms is not known. We suspect the radiological findings are probably due to a combination of injectate within the colonic wall and leakage of insufflated air or CO2 following transmural passage of the EMR needle. As EMR is becoming an increasingly effective treatment modality in the management of large sessile polyps, clinicians need to be aware of potential complications of treatment. It is also important to recognise that radiological features of perforation can be seen post EMR in the absence of an EMR associated perforation.
authors.affiliation: Neel Heerasing, Damian Dowling, Sina Alexander, Department of Gastroenterology, Barwon Health, Geelong, Victoria 3220, Australia.
authors.forename: Neel
authors.initials: N
authors.lastname: Heerasing
authors.forename: Damian
authors.initials: D
authors.lastname: Dowling
authors.forename: Sina
authors.initials: S
authors.lastname: Alexander
keywords: Abdominal pain; Colonoscopy; Computed tomography scan; Endoscopic mucosal resection; Perforation
references.citation: Gastrointest Endosc. 2009 Dec;70(6):1128-36
references.pmid: 19748615
references.citation: Gastroenterology. 2011 Jun;140(7):1909-18
references.pmid: 21392504