title: Complication of endoscopic tattooing: a case report of covered perforation.
abstract: OBJECTIVE
  Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively.
  
  
  METHODS
  63 years old woman, underwent colonoscopy for lipoma tattooing with India ink SPOT® solution kit and saline test. Immediately after the procedure the patient has been referred the appearance of colic epi-mesogastric pain and fever; Computed Tomography (CT) without MDC identified an irregular thickening of transverse colon with some microbubbles compatible with focal peritonitis. Initial paralytic ileus was present too. The blood count and metabolic panel examinations reveal a neutrophil leucocytosis (WBC: 11.000/mmc, 80% neutrophils).
  
  
  RESULTS
  On the base of WSES sepsis severity score and recent literature patient was treated conservatively with total parenteral nutrition, and intravenous antibiotic therapy. After the resolution of fever and reactivation of peristalsis. The discharge occurred after six days with no early complications.
  
  
  CONCLUSIONS
  India ink tattooing with SPOT® solution kit and saline test represent the first choice. It is a feasible technique although perforation is a possible complication. It may need an immediately surgical operation but in most cases a conservative management is a good and safe tool even if surgery may be attempted too.
authors.forename: N
authors.initials: N
authors.lastname: Falco
authors.forename: T
authors.initials: T
authors.lastname: Fontana
authors.forename: R
authors.initials: R
authors.lastname: Tutino
authors.forename: C
authors.initials: C
authors.lastname: Raspanti
authors.forename: A
authors.initials: A
authors.lastname: Mascolino
authors.forename: I
authors.initials: I
authors.lastname: Melfa
authors.forename: G
authors.initials: G
authors.lastname: Scerrino
authors.forename: G
authors.initials: G
authors.lastname: Salamone
authors.forename: G
authors.initials: G
authors.lastname: Gulotta
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology* / Q000628:therapy; D002244:Carbon / Q000009:adverse effects*; D003113:Colonoscopy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000175:diagnosis; D004396:Coloring Agents / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008067:Lipoma / Q000175:diagnosis; D008875:Middle Aged; D013653:Tattooing / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004396:Coloring Agents; C028433:chinese ink; D002244:Carbon