Acute colonic pseudo-obstruction (ACPO) is characterized by massive colonic dilatation
without mechanical obstruction [1]. Typically, it develops in hospitalized patients with serious underlying medical
and surgical conditions such as sepsis and respiratory failure [2]. We report a case of postpolypectomy ACPO.
A 51-year-old gentleman with liver cirrhosis presented for screening colonoscopy as
the workup for liver transplantation. We used fentanyl 75 μg and midazolam 4 mg for
conscious sedation. During the procedure, eight polyps ranging in size from 5 to 12 mm
were removed with snare cautery. We used a moderate amount of air for colon insufflation.
After the procedure, the patient developed abdominal distension, nausea and vomiting,
and generalized pain. He was observed in our postprocedure care unit. An abdominal
radiograph showed massive colonic dilatation without signs of perforation ([Fig. 1]). He was given nothing by mouth; intravenous hydration was administered. Repeat
abdominal radiographs at 24 and 48 hours showed persistent colonic distension, but
no signs of perforation. The patient remained afebrile.
Fig. 1 Abdominal X-ray. Persistent dilated loops of bowel seen after colonoscopy.
After around 60 hours of persistent colonic dilatation, a rectal tube was placed.
This resulted in gradual improvement in the abdominal distension over a few hours.
The patient did very well thereafter and was discharged home in a stable condition.
There was no recurrence.
The pathogenesis of ACPO is not completely understood, but it probably results from
an imbalance in the autonomic regulation of colonic motor function, leading to excessive
parasympathetic suppression or sympathetic stimulation [3]. In our patient, the reason for ACPO was not clearly identified. We hypothesize
that it was most likely secondary to electric burn to the colonic mucosa resulting
from the extensive polypectomy. This resulted in persistent colonic dilatation even
as far out as almost 3 days after the procedure.
It is important to consider ACPO in the differential diagnosis of abdominal distension
after colonoscopy with polypectomy.
Endoscopy_UCTN_Code_CPL_1AJ_2AC
