Korean J Gastroenterol.  2014 Jul;64(1):45-48. 10.4166/kjg.2014.64.1.45.

Colonic Abscess Induced by India Ink Tattooing

• Bang CS
• Kim YS
• Baik GH
• Han SH

• KMID: 1791894
• DOI: http://doi.org/10.4166/kjg.2014.64.1.45

Abstract

Endoscopic tattooing with India ink is generally regarded as a safe procedure that enables ready identification of endoluminal cancer from the serosal surface. However, significant complications have been reported, including local inflammatory pseudotumor formation, peritonitis, rectus muscle abscess, small bowel infarction, and phlegmonous gastritis. Although the mechanism of complication is not completely understood, it may be related to the chemical compounds contained in the ink solution and enteric or extraenteric bacterial inoculation by injection needle or the ink itself. Authors encountered a case of a 60-year-old man with a resectable sigmoid colon cancer which was tattooed with India ink for subsequent localization in the intraoperative setting. During the laparoscopic operation, the proximal and distal margin of the lesion appeared edematous with bluish color. The distal resection margin was extended approximately 5 cm more than expected because of long extent of edematous mucosa. Histologic examination of the edematous tattooing area revealed an ink abscess spreading laterally above the muscularis propria. Although tattooing is widely used and relatively safe, the presented case indicates the risk of infection or inflammation by tattooing.

Keyword

Tattooing; Adverse effects; Abscess; Chinese ink

MeSH Terms

Abscess/*diagnosis/etiology/pathology
Carbon/*adverse effects
Colonoscopy
Humans
Intestinal Mucosa/pathology/surgery
Laparoscopy
Male
Middle Aged
Sigmoid Neoplasms/surgery
*Tattooing
Carbon

Figure

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  Fig. 1. Colonoscopic India ink tattooing. (A) A 2-cm sized ulcerofungating mass in the mid sigmoid colon. (B) A 1.0-mL submucosal injection was made at the proximal and distal border of the lesion (total of 2.0 mL).

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  Fig. 2. Gross findings. Resected specimen shows two injection sites with edematous mucosa.

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  Fig. 3. Histologic findings. Large collection of polymorphonuclear cells, macrophages, and black pigments in the submucosa. Neutrophils infiltrated into the subserosa, invading muscularis propria (H&E, ×100).

Reference

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