Postpolypectomy coagulation syndrome (Postpolypectomy syndrome or PPCS) is a condition that occurs following

colonoscopy Colonoscopy () or coloscopy () is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis ( ...

with

electrocautery Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, ...

polypectomy In medicine, a polypectomy is the removal of an abnormal growth of tissue called a polyp. Polypectomy can be performed by excision if the polyp is external (on the skin). See also * Colonic polypectomy Colonic polypectomy is the removal of c ...

, which results in a burn injury to the wall of the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans a ...

. The condition results in

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. About 15% of people have a m ...

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

elevated white blood cell count Leukocytosis is a condition in which the white cell (leukocyte count) is above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following certain para ...

and elevated serum

C-reactive protein C-reactive protein (CRP) is an annular (ring-shaped) pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin ...

Signs and symptoms

PPCS causes abdominal pain and fever. The condition usually onsets within 1–5 days after colonoscopy with polypectomy using electrocautery. Physical examination may show evidence of peritonitis.

Etiology

PPCS is caused by an electrocautery-induced injury to the wall of the colon that occurs during removal of colon polyps. PPCS occurs when the electric current extends beyond the mucosa, entering the muscularis propria and serosa, resulting in a full thickness (transmural) burn injury. The transmural burn results in localized inflammation of the peritoneum (peritonitis).

Diagnosis

PPCS may resemble perforation. Recognition of PPCS is important, since treatment usually does not require surgery, unlike gastrointestinal perforation. Laboratory studies may show elevated white blood cell count (

leukocytosis Leukocytosis is a condition in which the white cell (leukocyte count) is above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following certain parasi ...

) and elevated inflammatory markers such as

. CT scan of the abdomen may show severe mural thickening, without air present outside the gastrointestinal tract.

Treatment

Treatment of PPCS consists of intravenous fluids, antibiotics, and avoiding any oral intake of food, water, etc. until symptoms improve.

Prevention

Some low quality evidence suggests that antibiotic prophylaxis may prevent PPCS.

Epidemiology

PPCS occurs about 1% of cases following polypectomy with electrocautery. Risk factors for PPCS include right colon polypectomy, large polyp size (>2 cm), non-polypoid lesions (laterally spreading lesions), and hypertension.

References

{{reflist Endoscopy Gastroenterology