Skip to main content
Erschienen in: Clinical Journal of Gastroenterology 5/2020

09.07.2020 | Case Report

Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants

verfasst von: Yoshinori Sato, Yusuke Satta, Hiroshi Yasuda, Hirofumi Kiyokawa, Masaki Yamashita, Yasumasa Matsuo, Fumio Itoh

Erschienen in: Clinical Journal of Gastroenterology | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

We describe the case of an 84-year old female who was taking rivaroxaban 30 mg/day and had a medical history of atrial fibrillation. She underwent endoscopic mucosal resection of a 5-mm adenoma located in the hepatic flexure of the transverse colon. Following the procedure, she developed gradually intensifying abdominal pain, with the appearance of small amount of blood in the feces. For that reason, she visited our facility on the 5th day post-endoscopic mucosal resection. At the time of the visit, contrast-enhanced abdominal computed tomography revealed no extravasation or free air; however, bloody ascites was confirmed in the peritoneal cavity. Thus, the patient was diagnosed with post-endoscopic mucosal resection intra-abdominal hemorrhage and hospitalized the same day. After admission, rivaroxaban was discontinued and patient condition monitored. Because subsequent abdominal computed tomography revealed no distinct increase in bloody ascites, no interventional radiological or surgical procedure was performed, and the patient was discharged after providing only conservative treatment. While hemorrhage and perforation are the main complications after colonic endoscopic mucosal resection, so far, there have been a few reports on the occurrence of intra-abdominal hemorrhage following endoscopic mucosal resection. Emergency treatment is sometimes required in patients with intra-abdominal hemorrhage. It is important to keep in mind that this complication, although very rare, may occur, particularly in patients taking anticoagulants.
Literatur
1.
Zurück zum Zitat Gillen S, Martetschlager F, Friess H, et al. Massive intra-abdominal bleeding caused by nontraumatic rupture of vein in the colorectal ligament: report of a case. Surg Today. 2011;41:415–7.CrossRef Gillen S, Martetschlager F, Friess H, et al. Massive intra-abdominal bleeding caused by nontraumatic rupture of vein in the colorectal ligament: report of a case. Surg Today. 2011;41:415–7.CrossRef
2.
Zurück zum Zitat Sagar J, Kumar V, Shah DK, et al. Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature. BMC Blood Disord. 2006;6:7. Sagar J, Kumar V, Shah DK, et al. Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature. BMC Blood Disord. 2006;6:7.
3.
Zurück zum Zitat Hassan I, Rasmussen TE, Schwarze U, et al. Ehlers–Danlos syndrome type IV and a novel mutation of the type III procollagen gene as a cause of abdominal apoplexy. Mayo Clin Proc. 2002;77:861–3.CrossRef Hassan I, Rasmussen TE, Schwarze U, et al. Ehlers–Danlos syndrome type IV and a novel mutation of the type III procollagen gene as a cause of abdominal apoplexy. Mayo Clin Proc. 2002;77:861–3.CrossRef
4.
Zurück zum Zitat Wherry DC, Zehner H Jr. Colonoscopy-fiberoptic endoscopic approach to the colon and polypectomy. Med Ann Dist Columbia. 1974;43:189–92. Wherry DC, Zehner H Jr. Colonoscopy-fiberoptic endoscopic approach to the colon and polypectomy. Med Ann Dist Columbia. 1974;43:189–92.
5.
Zurück zum Zitat Singla S, Keller D, Thirunavukarasu P, et al. Splenic injury during colonoscopy-a complication that warrants urgent attention. J Gastrointest Surg. 2012;16:1225–34.CrossRef Singla S, Keller D, Thirunavukarasu P, et al. Splenic injury during colonoscopy-a complication that warrants urgent attention. J Gastrointest Surg. 2012;16:1225–34.CrossRef
6.
Zurück zum Zitat Poon C-M, Lee F-Y, et al. A rare complication of intra-abdominal hematoma after ERCP. Gastrointest Endosc. 2002;2:307.CrossRef Poon C-M, Lee F-Y, et al. A rare complication of intra-abdominal hematoma after ERCP. Gastrointest Endosc. 2002;2:307.CrossRef
7.
Zurück zum Zitat Voudoukis E, Spiridakis KG, Karmiris K, et al. Intramural hematoma of the ascending colon leading to intraperitoneal hemorrhage: a possible post-polypectomy complication. Ann Gastroenterol. 2012;25:265–7. Voudoukis E, Spiridakis KG, Karmiris K, et al. Intramural hematoma of the ascending colon leading to intraperitoneal hemorrhage: a possible post-polypectomy complication. Ann Gastroenterol. 2012;25:265–7.
8.
Zurück zum Zitat Neese A, Grade M, Dango S, et al. A case report of delayed intra-abdominal and intra-luminal hemorrhage after polypectomy. Z Gastroenterol. 2017;55:1009–13.CrossRef Neese A, Grade M, Dango S, et al. A case report of delayed intra-abdominal and intra-luminal hemorrhage after polypectomy. Z Gastroenterol. 2017;55:1009–13.CrossRef
9.
Zurück zum Zitat Shanker S, Rowe S. Splenic injury after colonoscopy: case report and review of literature. Ochsner J. 2011;11:276–81. Shanker S, Rowe S. Splenic injury after colonoscopy: case report and review of literature. Ochsner J. 2011;11:276–81.
10.
Zurück zum Zitat Tagg W, Woods S, Razdan R, et al. Hemoperitoneum after colonoscopy. Endoscopy. 2008;40:E136–7.CrossRef Tagg W, Woods S, Razdan R, et al. Hemoperitoneum after colonoscopy. Endoscopy. 2008;40:E136–7.CrossRef
11.
Zurück zum Zitat Khosla M, Webster L, Ahmad K, et al. Hemoperitoneum as a consequence of colonoscopy. ACG Case Rep J. 2016;3:e103.CrossRef Khosla M, Webster L, Ahmad K, et al. Hemoperitoneum as a consequence of colonoscopy. ACG Case Rep J. 2016;3:e103.CrossRef
12.
Zurück zum Zitat García-Martos E, Vara-Brenes D, Prados-Manzano R, et al. Hemoperitoneum: a rare complication after diagnostic colonoscopy. Gastroenterol Hepatol. 2015;38:409–10 (Article in Spanish).CrossRef García-Martos E, Vara-Brenes D, Prados-Manzano R, et al. Hemoperitoneum: a rare complication after diagnostic colonoscopy. Gastroenterol Hepatol. 2015;38:409–10 (Article in Spanish).CrossRef
13.
Zurück zum Zitat Kobayashi N, Yoshitake N, Hirahara Y, et al. Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol. 2012;27:728–33.CrossRef Kobayashi N, Yoshitake N, Hirahara Y, et al. Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol. 2012;27:728–33.CrossRef
14.
Zurück zum Zitat Nakajima T, Saito Y, Tanaka S, et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc. 2013;9:3262–70.CrossRef Nakajima T, Saito Y, Tanaka S, et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc. 2013;9:3262–70.CrossRef
15.
Zurück zum Zitat Watabe H, Yamaji Y, Okamoto M, et al. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc. 2006;64:73–8.CrossRef Watabe H, Yamaji Y, Okamoto M, et al. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc. 2006;64:73–8.CrossRef
16.
Zurück zum Zitat Boumitri C, Mir FA, Ashraf I, et al. Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review. Ann Gastroenterol. 2016;29:502–8. Boumitri C, Mir FA, Ashraf I, et al. Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review. Ann Gastroenterol. 2016;29:502–8.
Metadaten
Titel
Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants
verfasst von
Yoshinori Sato
Yusuke Satta
Hiroshi Yasuda
Hirofumi Kiyokawa
Masaki Yamashita
Yasumasa Matsuo
Fumio Itoh
Publikationsdatum
09.07.2020
Verlag
Springer Singapore
Erschienen in
Clinical Journal of Gastroenterology / Ausgabe 5/2020
Print ISSN: 1865-7257
Elektronische ISSN: 1865-7265
DOI
https://doi.org/10.1007/s12328-020-01181-w

Weitere Artikel der Ausgabe 5/2020

Clinical Journal of Gastroenterology 5/2020 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.