Post-polypectomy coagulation syndrome occurs during a colonoscopic polypectomy procedure when electrocoagulation injury causes a transmural burn to the colon without radiographic evidence of perforation 1,2.
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Terminology
Post-polypectomy coagulation syndrome is also known as post-polypectomy syndrome, transmural burn syndrome, or post-polypectomy electrocoagulation syndrome.
Epidemiology
Post-polypectomy coagulation syndrome is a rare complication with an incidence between 0.07-1.0% 1,2. A retrospective cohort study determined the condition occurred in 6 of 16,318 colonoscopic polypectomy procedures 3.
Risk factors
- polypectomy to the right side of the colon
- large lesion size (>2 cm)
- hypertension
- non-polypoid lesion structure 1,2,4
Clinical presentation
Patients with post-polypectomy coagulation syndrome develop symptoms within several hours to five days post-procedure 2. Typical symptoms can mimic colonic perforation and include fever, tachycardia, abdominal pain, leukocytosis and localized peritonitis 1,2.
Pathology
Etiology
An electrical current is applied to the colonic mucosa during a polypectomy. If the current extends beyond the mucosa and injuries the muscularis propria and serosa, a transmural thermal injury develops and causes localized peritoneal inflammation 1.
Radiographic features
Plain radiograph
Plain radiography has a low sensitivity for free gas, with up to 23% of cases not visible on imaging 5. If there is a high index of suspicion for perforation, a CT should be acquired 6.
CT
CT remains the imaging modality of choice in diagnosing post polypectomy coagulation syndrome. Suggestive findings on CT in patients following colonoscopic polypectomy is localized bowel wall thickening at the site of polyp removal with a stratified enhancement pattern. There may be associated fat stranding but no evidence of extraluminal air to indicate perforation 6-8.
Treatment and prognosis
Unlike colonic perforation, post-polypectomy coagulation syndrome can be managed conservatively without surgical intervention. Treatment involves broad-spectrum antibiotics, intravenous fluids, bowel rest, analgesia, and observation 1,9.
Most patients are discharged from hospital after 3-5 days 1. Severe post-polypectomy coagulation syndrome occurs in only ~3% of cases, with no recorded deaths 1.
Differential diagnosis
- colonic perforation
- delayed lower gastrointestinal hemorrhage
- diverticulitis
Practical points
Early recognition of post-polypectomy coagulation syndrome and differentiation from perforation is important to avoid unnecessary hospitalization and surgery in a condition that can otherwise be managed conservatively 1,2.
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