A 43-year-old man was admitted to our hospital for polypectomy because of multiple
colonic polyps. He had no history of hemorrhage or abdominal trauma, and was not being
treated with anticoagulant therapy. His laboratory results, including coagulation
testing, were all normal. A ball-like polyp was identified in the descending colon
([Fig. 1 a]) and was removed using a snare to leave a 10-mm peduncle. The remaining four small
polyps (≤ 5 mm), located in the sigmoid colon and rectum, were removed using forceps.
Fig. 1 Colonoscopic views in a 43-year-old man with multiple colonic polyps showing: a a ball-like polyp in the descending colon that was removed using a snare; b the three clips that were placed on the post-polypectomy peduncle after the patient
passed bloody stools 32 hours later; c the bleeding intramural hematoma (70 × 50 × 40 mm) found near the peduncle during
a third colonoscopy that was performed 40 hours after the polypectomy when the patient
continued to show evidence of bleeding; d the hematoma, which had reduced in size and stopped bleeding, following treatment
with epinephrine.
The following morning, the patient ascended and descended a staircase for approximately
40 minutes. He later complained of having passed bloody stools, with a volume of approximately
150 mL, 32 hours after the polypectomy. We performed another colonoscopy and found
bleeding at the site of the peduncle in the descending colon. Three clips were placed
to stop the bleeding ([Fig. 1 b]).
Later the same day, 40 hours after polypectomy, the patient again passed bloody stools,
so we immediately performed a third colonoscopy. During this procedure we observed
an intramural hematoma (70 × 50 × 40 mm) near the site of the peduncle ([Fig. 1c]) and noted that the surrounding mucosa was ruptured and bleeding. We therefore injected
10 mL of 1 : 2000 epinephrine into the hematoma and two clips were used to repair
the rupture. Following treatment, the hematoma reduced in size and the bleeding ceased
([Fig. 1 d]). The patient was kept under observation for 3 days until he passed normal-colored
stools.
Significant intramural hematoma can occur in any part of the gastrointestinal tract
[1]. The small bowel, particularly the duodenum, is the site most frequently involved;
however intramural hematoma of the colon is a relatively rare event [2]. Spontaneous intramural hematomas are often the result of blunt trauma [3]. The typical causes of nontraumatic spontaneous hematoma are blood dyscrasia, anticoagulant
therapy, and other hematologic diseases. Intramural hematoma after polypectomy is
rarely observed.
Endoscopy_UCTN_Code_CPL_1AJ_2AC
