Imaging findings post colorectal endoscopic mucosal resection

Abstract

Endoscopic mucosal resection is commonly the treatment regime of choice for large sessile colonic polyps. We describe the computed tomography findings of a 51 year old female who presented with transient severe abdominal pain without systemic upset post endoscopic mucosal polyp resection, which resolved with conservative management. This is the second case in the literature that demonstrates 'normal' appearances post endoscopic mucosal resection. The clinical team and radiologist need to be aware of these findings when making management decisions in patients who present with acute pain post endoscopic mucosal resection.

How familiar are we with decision-making concerning the treatment of perforation after endoscopic mucosal resection (EMR) in the colon? A case report

“…On the CT findings of perforation generalized pneumoperitoneum or a localized collection of intra-peritoneal gas associated with the site of EMR, are commonly seen. It could also reveal free fluid with inflammatory stranding in the surrounding mesenteric fat, signs of peritoneal contamination that require urgent surgical consultation and possible restoration 4 . An effective algorithm on decision-making for the treatment of perforation seems to be crucial, when CT findings confirm the diagnosis of perforation, which could be linked to significant morbidity and mortality.…”

“…We would like to highlight ( Table 1 ) the presence and the amount of free air after an EMR do not correlate reciprocally with patientʼs pain after the procedure and that a radiological diagnosis of perforation is not always a true perforation with presence of a hole. There are 2 previous publications with disproportional relation between the amount of extraluminal air and patient’s pain after EMR procedure 4 6 . This was also true in our patient who had minimal gas with a small bubble outside the colon, but developed severe pain.…”