Endoscopy 2010; 42: E220
DOI: 10.1055/s-0030-1255644
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Small-bowel obstruction precipitated by bowel preparation for screening colonoscopy

J.  T.  Hlivko1 , E.  J.  Esber1 , J.  A.  Porter2 , C.  H.  Kefalas1
  • 1Department of Medicine, Summa Health System, Akron, Ohio, USA
  • 2Department of Surgery, Summa Health System, Akron, Ohio, USA
Further Information

Publication History

Publication Date:
28 September 2010 (online)

A 55-year-old man with a remote history of appendectomy presented to the emergency department 24 hours after undergoing a screening colonoscopy, complaining of persistent nausea, emesis, and worsening abdominal pain that began during a split-day bowel preparation with low-volume polyethylene glycol and bisacodyl tablets. The patient reported that he developed nausea and generalized abdominal cramping after he finished the first part of bowel preparation and then developed multiple episodes of emesis after the second part. However, his vital signs and abdominal exam were unremarkable and colonoscopy was performed without difficulty. At home he had recurrent nausea, emesis, and worsening abdominal pain, and therefore went to the emergency department. His abdomen was distended, tympanitic, and diffusely tender to palpation, with hypoactive, high-pitched bowel sounds and no peritoneal signs. Plain radiographs of the abdomen revealed no free air, but did indicate distension of the proximal and mid small bowel with multiple air-fluid levels ([Fig. 1]).

Fig. 1 Plain abdominal radiograph (upright) demonstrating distension of proximal and mid small bowel with multiple air-fluid levels.

After conservative management failed, the patient underwent a laparotomy which revealed an obstruction in the ileum secondary to a stricture caused by an adhesion.

The most common cause of small-bowel obstruction (SBO) is adhesions (65 % – 75 % of cases) [1]. The literature contains a few case reports of SBO secondary to colonoscopy [2] [3] [4] [5]. Ours is the first report of a SBO induced by bowel preparation. Review of the cases of colonoscopy-induced SBO, as well as of this present case, found that a common factor was prior abdominal surgery. The fact that symptoms of SBO started almost immediately after the patient’s bowel preparation was finished and before his arrival for the colonoscopy makes it less likely that the procedure itself induced SBO. The rare complication of SBO should be considered in a patient presenting with symptoms of nausea, vomiting, and abdominal pain at the time of colonoscopy.

Competing interests: None

Endoscopy_UCTN_Code_CPL_1AJ_2AB

References

J. T. Hlivko, MD 

Department of Medicine
Summa Health System

55 Arch Street, Suite 1A
Akron
Ohio 44304
USA

Fax: +1-330-375-3760

Email: jonhlivko@yahoo.com