Phlegmonous Colitis after Cold Snare Polypectomy in an Immunosuppressed Patient: A Case Report.

IF 0.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Case Reports in Gastroenterology Pub Date : 2024-03-07 eCollection Date: 2024-01-01 DOI:10.1159/000536487
Karen Kimura, Chikamasa Ichita, Chihiro Sumida, Takashi Nishino, Miki Nagayama, Jun Kubota, Haruto Hirose, Akiko Sasaki
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Abstract

Introduction: Cold snare polypectomy (CSP) is a procedure with a low risk of complications. Here, we present our experience of a rare case of submucosal abscess following CSP in an immunosuppressed patient.

Case presentation: Seventy-eight-year-old man underwent CSP, developing a fever, chills, and right lower abdominal pain 8 days later. Ultrasound and computed tomography revealed wall thickening of the ascending colon, presenting as whitening and thickening of the same region, and excretion of pus was observed after biopsy. The diagnosis was made as phlegmonous colitis, for which antibiotic therapy was commenced. The patient was diagnosed with chronic myelomonocytic leukemia (CMML) during admission. We considered the following reasons as possible causes of infectious complications after CSP: (1) the patient had a highly immunosuppressed state with comorbidities such as CMML as well as diabetes mellitus and (2) disruption of the mucosal barrier occurred during endoscopic resection.

Conclusion: Although CSP is generally considered safe, our case highlights the potential for serious complications in immunosuppressed patients. Therefore, the decision to perform CSP in such patients should be made with caution to avoid unnecessary interventions. In instances where treatment is essential, thorough bowel preparation and prophylactic antibiotic use may be necessary to mitigate the risks.

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免疫抑制患者冷卡式息肉切除术后的痰性结肠炎:病例报告。
简介冷套管息肉切除术(CSP)是一种并发症风险较低的手术。在此,我们介绍一例罕见的免疫抑制患者在接受 CSP 术后出现粘膜下脓肿的病例:78岁的男性接受了CSP手术,8天后出现发热、寒战和右下腹疼痛。超声波和计算机断层扫描显示升结肠壁增厚,表现为同一区域发白和增厚,活检后观察到脓液排出。诊断结果为痰性结肠炎,并开始使用抗生素治疗。患者入院时被诊断为慢性粒细胞白血病(CMML)。我们认为以下原因可能是 CSP 术后感染并发症的原因:(1)患者处于高度免疫抑制状态,患有 CMML 等合并症和糖尿病;(2)内镜切除时破坏了粘膜屏障:虽然 CSP 通常被认为是安全的,但我们的病例强调了免疫抑制患者发生严重并发症的可能性。因此,在决定对此类患者实施 CSP 时应慎之又慎,以避免不必要的干预。在必须进行治疗的情况下,可能有必要进行彻底的肠道准备并预防性使用抗生素,以降低风险。
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来源期刊
Case Reports in Gastroenterology
Case Reports in Gastroenterology Medicine-Gastroenterology
CiteScore
1.10
自引率
0.00%
发文量
99
审稿时长
7 weeks
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