A retrospective study of 63 patients with PLA showed that fever was common (59%), but other signs and symptoms such as right upper quadrant pain and peritoneal signs were present in only 39% and 14%, respectively. 7 However patients are still in grave danger, especially if the diagnosis is delayed, as it often is, because patients may present nonspecifically. 4-6 With advances in diagnostic techniques and interventions, mortality is improving. PLA is a dangerous disease with high morbidity and mortality that occurs at a rate of 10 to 20 cases per 100,000 hospital admissions. ED physicians must be aware of all possible complications and their time course and have the tools to correctly diagnose and treat the unlucky post-colonoscopy patient who suffers a serious complication. By contrast, gas explosion or immediate bleeding will rarely be seen in the ED, as these issues typically present rapidly in the endoscopy suite, where they are addressed emergently. Other late complications such as post-polypectomy electrocoagulation syndrome, and the more common problems of delayed hemorrhage, nonspecific abdominal pain, reactions to sedation agents, and perforation can also be seen in the ED. 4-6 Because of the delayed nature of PLA, these patients are likely to be diagnosed in the emergency department. Most complications of colonoscopy will present within 7 days, but PLA may present days or even weeks later than that, and the history of recent colonoscopy may not even be elicited unless the clinician is aware of this entity. Pyogenic liver abscess (PLA) is a rare but serious complication of colonoscopy. The risk of serious complications was also increased among patients with comorbid conditions such as a history of stroke, COPD, atrial fibrillation, and heart failure. In a study of 53,220 colonoscopies, patients aged 80 to 84 years had a significantly higher rate of serious complications compared with patients aged 66 to 69 years. Older adults are at increased risk for serious complications compared with younger patients. 2 However, the risk of colonoscopy is not constant across groups, and some complications are more common than others. A 2008 systematic review of 12 studies totaling 57,742 colonoscopies performed for average risk screening showed an overall serious adverse event rate of just 2. The procedure is still the most effective way to find and remove small pre-cancerous polyps, and thereby decrease the risk of death from colon and rectal cancer. 1 In high risk patients such as those with inflammatory bowel disease, colonoscopy is performed more often. According to the American Cancer Society, screening colonoscopy is recommended every 10 years starting at age 50. ![]() Resolution of all lesions occurred after they were drained by interventional radiology, and the patient was given a 6-week course of intravenous antibiotics.Ĭolonoscopy is a commonly performed procedure in the diagnosis and treatment of a wide range of conditions including cancer, inflammatory bowel diseases, polyps, bleeding, and strictures. Drainage of the abscesses was cultured and grew Streptococcus anginosus. A computed tomography (CT) scan of the abdomen revealed multiple areas of low-attenuation in the right hepatic lobe consistent with liver abscesses. Laboratory studies revealed an elevated white blood cell count (15,000) and elevated AST and ALT (120/137 U/L), with slightly elevated alkaline phosphatase of 200 IU/L. ![]() She had mild right upper abdominal tenderness. In the ED, the patient’s vital signs were HR 110, BP 120/80, RR 18, T 102.5. During colonoscopy, her Crohn’s disease was in remission, and there was no mucosal inflammation noted. Shortly before the onset of symptoms, the patient underwent an uncomplicated colonoscopy during which she had 17 biopsies performed for surveillance or polypectomy. ![]() ![]() Authors: Thomas Yang, MD (EM Resident Physician, Aventura Hospital and Medical Center, Aventura, FL) and Annalee Baker, MD (Assistant Program Director, Emergency Medicine Residency, Aventura Hospital and Medical Center, Aventura, FL) // Edited by: Alex Koyfman, MD and Brit Long, MD Clinical CaseĪ 45-year-old woman with a 20-year history of Crohn’s disease presented with fever, chills, and fatigue for 10 days.
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