Colorectal Surgery Department, Hospital Central Militar, México City, México (Dr. M. Gurieb-Trueba)
Advanced Endoscopy Department, Hospital Central Militar, México City, México (Dr. V. M. Rivera-Méndez)
Hospital San Ángel Inn Chapultepec, México City, México (Dr. J. C. Sánchez-Robbles)

ABSTRACT

Colorectal cancer prevention relies on effective screening through colonoscopy and polypectomy. Several techniques and methods have been described to manage complex colonic polyps such as the ones that are endoscopically unresectable. Across time, we have been able to perform less invasive techniques that include different types of colonic resections, ranging from partial thickness, full-thickness and, segmental colectomies, however, none has proven to be the treatment of choice for these lesions. The technique presented here is an attractive alternative to segmental colectomy using a robotic platform to perform a full-thickness resection.

Key Words: Robotic surgery, Combined approach, Polyp, Colon, Colonoscopy, Colon cancer, Minimally invasive surgery.

The post Combined Endoscopic-Robotic Resection of a Giant Polyp to Avoid Colorectal Resection first appeared on JSLS.

Santa Barbara Cottage Hospital, Santa Barbara, California, USA (Drs Loseth, Johnson, and Sharma)

ABSTRACT

Colonoscopy is a routine procedure to screen for colorectal cancer. Splenic injury is an extremely rare but potentially fatal complication. We present a case of a 74-year-old woman on edoxaban who underwent a screening colonoscopy at a nearby outpatient surgery center. While in the recovery room, she experienced abdominal pain, hypotension, and episodes of syncope, arriving to our Emergency Department approximately 10 hours after the colonoscopy. She presented to the Emergency Department with a distended abdomen, hypotensive, and with significant abdominal pain. Abdominal computed tomography scan showed significant hemoperitoneum around the bilateral paracolic gutters, spleen, and gastric fundus. She underwent emergent midline laparotomy with evacuation of 1.5 L of hemoperitoneum with ongoing bleeding from her deseroalized spleen, suggesting traction injury from colonoscopy. In patients with abdominal pain, hypotension, and low hemoglobin postcolonoscopy, splenic injury should be considered in order to recognize early and manage appropriately.

Key Words: Abdominal pain; Splenic injury; Colonoscopy; Spleen; Anticoagulant; Complication

The post Splenic Injury After Colonoscopy first appeared on JSLS.

Department of General Surgery, Modbury Hospital, Modbury, South Australia (all authors).

ABSTRACT

Background: Acute appendicitis after colonoscopy is a rare sequela and may be incidental or a true complication of colonoscopy. This review explores the cause and effect relationships between colonoscopy and the development of acute appendicitis.

Methods: We conducted a systematic review of the literature to identify articles up to July 2011. The following time intervals were collated from documented cases to evaluate the natural history of postcolonoscopy appendicitis: time from colonoscopy to symptom onset, time from symptom onset to presentation (preadmission delay), and time from symptom onset to surgery. Postadmission delay was then estimated.

Discussion: Paucity of published cases on postcolonoscopy appendicitis may be the result of acute appendicitis being incidental after colonoscopy or because of under-recognition of this complication. The close association between colonoscopy and the onset of symptoms of acute appendicitis suggests a relationship between the procedure and pathology. However, at present, the data available are inadequate to give firm details on the natural history of acute appendicitis after colonoscopy. Shared symptomatology and examination findings between postcolonoscopy appendicitis and common colonoscopic complications such as colonic perforation and postpolypectomy syndrome result in delayed diagnosis. Our findings suggest that delayed surgical intervention is associated with increased morbidity and mortality and is clinician dependent in a majority of cases.

Conclusion: Regardless of whether postcolonoscopy appendicitis represents an incidental finding or true complication of colonoscopy, consideration of acute appendicitis as a differential diagnosis of the acute abdomen after colonoscopy is important.

Key Words: Colonoscopy, Postcolonoscopy, Acute appendicitis.

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The post Acute Appendicitis Following Colonoscopy first appeared on JSLS.