General

Case Discussion -26082016

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26 Aug 2016 - General
 

An elderly patient with background of hypertension, previous stroke, ischeamic heart disease, and type 2 diabetes mellitus, attended for endoscopy procedures - day case (gastrosocpy and colonoscopy) with the indication of weight loss and iron deficiency ananemia. Gastroscopy was normal. Colonoscopy showed 5 polyps in the colon, which were all removed by either forcep of snare, and sent for histology. Post procedures, patient complainted of persistent abdominal pain, discomfort, rate the pain as 8-9/10, not relieving by analgesia given. On examination, his abdomen is slightly tender throughout, but no sign of acute surgical abdomen. What is your impression ? What will be your management plan or investigation ??

My impression would be post-polypectomy bleeding, which is the most common complication after colonoscopic removal of polyps. The patient has numerous risk factors for this condition: her old age, probable use of anticoagulants to prevent another stroke, and impaired wound healing secondary to diabetes mellitus. Plan would be to do immediate repeat colonoscopy which could be both diagnostic and therapeutic. Upon identification of bleeding site, injection of epinephrine and/or hemoclipping can be...
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