Kodama Yuu, Mizokami Yuji, Toyama Yuzo, Kusaka Hiroyasu, Maeda Gen, Asahara Shingo, Nagahama Ryuji, Horiguchi Shin-Ichiro, Aoyama Hiroki
Department of Gastroenterology New Tokyo Hospital Chiba Japan.
DEN Open. 2024 Sep 29;5(1):e70017. doi: 10.1002/deo2.70017. eCollection 2025 Apr.
We encountered a case of a large hematoma developing with perforation shortly after a cold snare polypectomy for a colorectal adenoma. The patient underwent cold snare polypectomy for a 3-mm type Is lesion in the transverse colon at another facility. Two hours later, she visited the emergency room due to abdominal pain. Contrast-enhanced computed tomography revealed a 70 mm, high-intensity mass in the transverse colon with contrast extravasation. We attempted transcatheter arterial embolization to stop the bleeding. Several hours later, the anemia had not worsened, but the severe abdominal pain persisted. Urgent laparoscopic right hemicolectomy was performed due to the possibility of gastrointestinal perforation. The surgery was successfully completed. Pathology reports confirmed the presence of an intramural hematoma in the proximal transverse colon with hemorrhagic infiltration of all layers, along with extensive ischemic changes. A perforation was identified in this area, with mucosal defects observed near the hole, possibly due to cold snare polypectomy.
我们遇到了一例在对结肠直肠腺瘤进行冷圈套息肉切除术后不久发生穿孔并伴有大血肿形成的病例。患者在另一家机构对横结肠一个3毫米的I s型病变进行了冷圈套息肉切除术。两小时后，她因腹痛前往急诊室。增强计算机断层扫描显示横结肠有一个70毫米的高强度肿块，伴有造影剂外渗。我们尝试进行经导管动脉栓塞术以止血。数小时后，贫血未加重，但严重腹痛持续存在。由于存在胃肠道穿孔的可能性，遂紧急进行了腹腔镜右半结肠切除术。手术成功完成。病理报告证实近端横结肠存在壁内血肿，全层有出血浸润，同时伴有广泛的缺血改变。在该区域发现了一个穿孔，在孔附近观察到黏膜缺损，可能是由于冷圈套息肉切除术所致。
