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ARGON PLASMA COAGULATION OF ANGIODYSPLASIA IN THE CECUM RESULTING IN INTESTINAL PERFORATION: TWO CASE REPORTS AND LITERATURE REVIEW
HD Dhaliwal, R Sy, N Saloojee
Department of Gastroenterology, University of Ottawa, Ottawa, ON
Argon plasma coagulation (APC) has been adopted into general gastrointestinal practice as an effective and theoretically safer approach to cauterization. The advantage of APC is a decreased depth of penetration and a tendency for the ionized arc of electrical current to deflect away from coagulated tissue to surrounding areas making complications such as intestinal perforation rare. However, other complications can occur including subcutaneous emphysema, subcutaneous bubbling of gas and pneumoperitoneum.
In this paper we report two cases of intestinal perforation secondary to APC. In the first case, cecal angiodysplasias identified during a screening colonoscopy were coagulated using APC resulting in fee air in the abdomen and confirmed cecal perforation during surgery. This patient did not survive due to post operative complications. The second case also involved a patient with multiple angiodysplastic lesions of the cecum treated with APC resulting again in intestinal perforation. This patient survived with conservative treatment consisting of antibiotics and bowel rest.
A review of the literature reveals minimal complications in the utilization of APC. Large case series have reported rates of perforation as low as 0.2%.
We cite these two cases as documentation that intestinal perforation in the cecum is a concern with APC due to the thinness of the colonic wall in the cecum compared to other areas of the colon. Further review is needed to assess safety of this modality with regards to treatment of cecal lesions.