Endoscopy 2010; 42: E221-E222
DOI: 10.1055/s-0029-1214967
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Postcolonic polypectomy pancreatitis

J.  I.  Fortea1 , I.  Marín Jimenez1 , O.  Nogales Rincon1 , V.  Flores Fernandez1 , T.  Savescu1 , A.  Madrid Vallenilla1 , P.  Menchen Fernandez-Pacheco1
  • 1Service of Digestive Diseases, Hospital Gregorio Marañon, Madrid, Spain
Further Information

I. M. Jimenez, MD 

Service of Digestive Diseases
Hospital Gregorio Marañon

Dr Esquerdo 48
Madrid 28007
Spain

Fax: +34-1-914265024

Email: drnachomarin@hotmail.com

Publication History

Publication Date:
07 October 2010 (online)

Table of Contents

    A 71-year-old man, who was following a colonoscopy surveillance program for previous colonic polyps, attended our endoscopy unit for routine colonoscopy. He had undergone his last endoscopic procedure in February 2007, during which a total of five polyps were resected (size range 7 – 15 mm). Histological examination revealed adenomatous polyps with low-grade dysplasia.

    The surveillance colonoscopy found three new polyps. One in the right colon (10 mm in size), another in the proximal transverse colon (8 mm), and a third in the distal transverse colon (25 mm) ([Fig. 1]). The first two were resected using a cold forceps; for the third and largest polyp, however, we used a snare and endocut (ERBE ICC 200, Tübingen, Germany) following the injection of 5 mL of saline and 2 mL of adrenaline 1 : 10 000 to facilitate resection and to prevent bleeding. Finally, it was necessary to use argon plasma coagulation (40 W, Q 1.8 L/minute) in order to eradicate some fragments that were technically difficult to resect ([Fig. 2]).

    The patient presented at the emergency room 12 hours after the procedure with epigastric pain and hyperamylasemia. Liver function tests showed a slight elevation of aminotransferases and bilirubin (less than twice the upper limit of normal). He was then diagnosed with pancreatitis, after other causes of hyperamylasemia had been excluded. Once admitted to our hospital, he underwent abdominal ultrasonography and computed tomography (CT), both of which did not demonstrate cholelithiasis, choledocholithiasis or any other potential cause of pancreatitis. Pancreatic inflammation seen with CT was limited to the pancreatic tail, which was in close relation to the distal transverse colon, where the largest polyp had been resected ([Fig. 3]).

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    Fig. 1 Colonic polyp.

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    Fig. 2 Colonic polyp resection.

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    Fig. 3 Pancreatitis of the tail in close relation to the colon.

    Postpolypectomy pancreatitis due to the use of endocut was considered to be the most probable diagnosis. The patient had an uneventful recovery with conservative management, and was discharged from hospital a week later.

    Endoscopy_UCTN_Code_CPL_1AJ_2AC

      I. M. Jimenez, MD 

      Service of Digestive Diseases
      Hospital Gregorio Marañon

      Dr Esquerdo 48
      Madrid 28007
      Spain

      Fax: +34-1-914265024

      Email: drnachomarin@hotmail.com

        I. M. Jimenez, MD 

        Service of Digestive Diseases
        Hospital Gregorio Marañon

        Dr Esquerdo 48
        Madrid 28007
        Spain

        Fax: +34-1-914265024

        Email: drnachomarin@hotmail.com

        Zoom Image

        Fig. 1 Colonic polyp.

        Zoom Image

        Fig. 2 Colonic polyp resection.

        Zoom Image

        Fig. 3 Pancreatitis of the tail in close relation to the colon.