Video Endoscopic Sequence 1 of 46.
Laparoscopically Surgery for Colonic Perforation with Peritonitis.
This is the case of a 51 year-old female, that underwent a polypectomy of a polyp in the cecum that was carried out in another clinic, ten hours after that patient began with mild abdominal pain located in the right iliac fossa, the abdomen was soft and tender and no rebound was detected.
Laboratory tests indicated an elevated White cell count of 16 500 with 82.9% neutrophils, patient was hospitalized with the presumptive diagnosis of transmural burn syndrome.
Post polypectomy electrocoagulation syndrome (also known as postpolypectomy syndrome and transmural burn syndrome) refers to the development of abdominal pain, fever, leukocytosis, and peritoneal inflammation in the absence of frank perforation that occurs after polypectomy with electrocoagulation Recognition of postpolypectomy syndrome is important to avoid unnecessary exploratory laparotomy since it resolves with conservative treatment in the majority of patients.
Postpolypectomy syndrome develops when electrical current applied during polypectomy extends past the mucosa into the muscularis propria and serosa, resulting in a transmural burn without perforation . Serosal irritation leads to a localized inflammatory response that manifests clinically as a localized peritonitis.
The second day in the hospital, patient had a severe abdominal paint with felling of shortness of breath, with abrupt onset of acute abdomen with severe generalized abdominal pain, tenderness, and peritoneal signs. Pain was radiated to the shoulder, An abdominal series (supine and upright abdominal x -rays and chest x-rays), showing free air under the diaphragm. The transmural burn syndrome had evolved to colon perforation.
This was managed successfully by exploratory laparoscopy and peritoneal lavage with drainage. The perforation was repaired at a laparoscopy using intracorporeal suturing.