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ACUTE COLONIC PSEUDO-OBSTRUCTION AND PANCREATITIS POST COLONOSCOPY
H Ko, TW Jamieson, A Ramji, B Bressler
Department of Medicine, University of British Columbia, Vancouver, BC
Post polypectomy bleeding and perforation are among the most common potential complications of colonoscopy. We present a case of acute colonic pseudo-obstruction and pancreatitis after colonoscopy. A 60-year-old Caucasian female with a previous cadaveric renal transplant (currently normal renal function) underwent a gastroscopy and colonoscopy for investigation of her iron deficiency anemia. The gastroscopy was normal; however, the colonoscope could not pass the splenic flexure due to a tight angulation. Two polypectomies with snare coagulation were performed in the descending colon. Within 24 hours post procedure, the patient experienced worsening abdominal pain which required admission. On exam, she had a distended, tender abdomen. Laboratory investigations revealed Hb 100g/L, WBC 12.9G/L, creatinine 145 umol/L (baseline), amylase 511 U/L, AST 19 U/L, ALT 14 U/L, ALP 52 U/L, GGT 24 U/L, and total bilirubin 11 umol/L. Abdominal X-ray and CT showed an ileus with air fluid levels and a dilated cecum, no evidence of perforation or mechanical obstruction. The tail of the pancreas was enlarged with associated mesenteric stranding and free fluid, suggestive of pancreatitis. The patient had none of the usual etiologic factors associated with pancreatitis. Since the patient had minimal improvement with conservative measures, a repeated colonoscopy and placement of a colonic decompression tube were performed. The repeated colonoscopy showed only mild ischemic changes in the ascending colon with no other structural abnormalities. The patient had considerable relief of her symptoms after the procedures and was later discharged home. The only identifiable cause of this patient’s acute colonic pseudo-obstruction and pancreatitis was procedure related. A potential etiology for the development of pancreatitis post colonoscopy is blunt trauma. Since the tail of the pancreas lies in close proximity to the splenic flexure, manipulation of the colonoscope through the flexure might produce trauma to the pancreas tail. One other possible explanation is that overcauterization during polypectomy may cause a transmural colonic burn that may also cause pancreatitic irritation. Our patient could have developed ileus secondary to procedure-induced acute pancreatitis. In summary, this case illustrates a unique complication of colonoscopy – pancreatitis.