Amyloidosis-associated delayed postpolypectomy bleeding

We read with great interest the article by Sawhney et al. about the risk factors for delayed postpolypectomy bleeding [1]. They concluded in their case–control study that greater polyp diameter was associated with increased risk of postpolypectomy bleeding. Herein, we report a delayed gastrointestinal bleeding after polypectomy.

The patient was a 49-year-old woman with familial mediterranean fever and end-stage renal failure due to amyloidosis, who underwent colonoscopy for abdominal pain. She was on a twice-a-week hemodialysis program. Her colonoscopy findings were normal except for a 3 – 4-mm diameter polyp in the sigmoid colon. Polypectomy was done with a biopsy forceps. During polypectomy, and in the immediate postcolonoscopy hours, there was no hematochezia. She was in a stable medical condition. At 20 hours postcolonoscopy, the patient reported a rectal hemorrhage for the first time. Colonoscopy was repeated and showed an oozing hemorrhage from the polypectomy site in the sigmoid colon ([Fig. 1]). The patient’s hemoglobin level dropped from 12.5 g/dL to 10.5 g/dL and she required 2 units of blood transfusion. She had no known medical history for hemorrhagic diathesis, and her platelet count and prothrombin time were within normal ranges. Sclerotherapy with adrenalin 1/10 000 solution ended the bleeding.

Fig. 1 Oozing hemorrhage from polypectomy site.

Amyloidosis is characterized by the extracellular deposition of amyloid protein in various organs. Gastrointestinal involvement in amyloidosis is common, even though the diagnosis of amyloidosis is often delayed [2]. Severe gastrointestinal hemorrhage in amyloidosis is rare but can be severe in some cases [3] [4]. We note the possible increased risk of delayed hemorrhage due to amyloid angiopathy, and suggest that strict follow-up in the postpolypectomy period is worthwhile even if the polyp is diminutive.

Competing interests: None

References

• 1 Sawhney M S, Salfiti N, Nelson D B. et al . Risk factors for severe delayed postpolypectomy bleeding.  Endoscopy. 2008;  40 115-119
• 2 Petre S, Shah I A, Gilani N. Review article: gastrointestinal amyloidosis – clinical features, diagnosis and therapy.  Aliment Pharmacol Ther. 2008;  27 1006-1016
• 3 Kim S H, Kang E J, Park J W. et al . Gastrointestinal amyloidosis presenting with multiple episodes of gastrointestinal bleeding.  Cardiovasc Intervent Radiol. 2008 Sep 17 [Epub ahead of print]; 
• 4 Usui M, Matsuda S, Suzuki H. et al . Gastric amyloidosis with massive bleeding requiring emergency surgery.  J Gastroenterol. 2000;  35 924-928