Surgery>>>>>Colon, Rectum, and Anus
Question 34#

A 50-year-old woman presents to the ED after having her first colonoscopy on her birthday. She endorses left lower quadrant abdominal pain and is febrile to 38.5°C. What complications after a colonoscopy require emergent laparotomy?

A. Small perforation in a stable patient
B. Hypotension and temperature of 38°C in an otherwise stable patient
C. Rigid abdomen and severe abdominal pain in a patient with poor bowel preparation
D. Findings of a large, flat sessile polyp

Correct Answer is C

Comment:

Complications of polypectomy include perforation and bleeding. A small perforation (microperforation) in a fully prepared, stable patient may be managed with bowel rest, broad-spectrum antibiotics, and close observation. Signs of sepsis, peritonitis, or deterioration in clinical condition are indications for laparotomy. Bleeding may occur immediately after polypectomy or may be delayed. The bleeding will usually stop spontaneously, but colonoscopy may be required to resnare a bleeding stalk or cauterize the lesion. Occasionally angiography and infusion of vasopressin may be necessary. Rarely, colectomy is required.