Korean J Gastroenterol.  2024 Sep;84(3):132-137. 10.4166/kjg.2024.083.

A Case of Colonic Intussusception with Post-polypectomy Electrocoagulation Syndrome and Review of Literature: How to Manage Intussusception Following Colonoscopy?

• Kim KH
• Kim JS
• Lee MS
• Han HY
• Kim JH

• KMID: 2559847
• DOI: http://doi.org/10.4166/kjg.2024.083

Abstract

Colonic intussusception is often reported to be related to malignancy in adults. Colonoscopy itself with or without polypectomy is known to be a rare cause of colonic intussusception. We encountered a case in which an individual was diagnosed with intussusception following colonoscopy. The patient was a 44-year-old female who, on the same day, had undergone a colonoscopy including endoscopic mucosal resection for a polyp in the ascending colon. She visited the emergency room with complaints of right-sided abdominal pain. Abdominal examination revealed peritoneal irritation in the right upper quadrant. Abdominal CT revealed colocolic intussusception near the hepatic flexure. This was suspected to have been induced by post-polypectomy electrocoagulation syndrome. A laparoscopic right hemicolectomy was performed because conducting a reduction trial through colonoscopy involves a high risk of peritonitis, in addition to a low likelihood of spontaneous reduction of intussusception due to the additional edema and ischemia resulting from the polypectomy. The patient was discharged without complications six days after the surgery. Though some cases have been reported, there is no treatment strategy for intussusception following colonoscopy. Therefore, we report this case of colonic intussusception following colonoscopy, which was found to be caused by Post-polypectomy Electrocoagulation Syndrome, with a literature review.

Keyword

Colon; Colonoscopy; Intussusception; Polyps; Treatment

Figure

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  Fig. 1 (A) Initial colonoscopic image showing a 20 mm-sized, sessile type adenoma located at the ascending colon. (B–D) Colonoscopic view after endoscopic mucosal resection using hot snare with saline injection.

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  Fig. 2 Abdominal CT, showing colocolic intussusception (arrow). (A) Coronal view (left). (B) Axial view (right) showing a target-like lesion in the right side of the colon with bowel and fatty mesentery inside along with colon wall thickening with submucosal swelling and highly attenuated infiltration of adjacent pericolic fat compatible with post-polypectomy electrocoagulation syndrome.

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  Fig. 3 Laparoscopic view of colocolic intussusception showing the distal part of the ascending colon drawn into the proximal part of the transverse colon.

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  Fig. 4 Histopathologic examination of the resected colon, compatible with post-polypectomy coagulation syndrome. (A) A deep ulcer (thin arrow) with transmural inflammation following the polypectomy (H&E ×12.5) (left). (B) Marked submucosal edema with diffuse neutrophilic infiltration, indicating acute suppurative inflammation (H&E ×100) (right).

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  Fig. 5 Algorithm used to treat intussusception following colonoscopy. The following points should be considered when deciding upon a treatment strategy: 1) complete or incomplete inspection of quality colonoscopy up to intussusception location, 2) risk of bowel ischemia or perforation or presence of post-polypectomy syndrome (PPES), and 3) clinical improvement following conservative treatment.

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