Pancreatitis should be considered a rare potential complication for patients who develop acute abdominal pain after colonoscopy.
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Procedural difficulties particularly around the splenic flexure, transmural colonic burns, and over-insufflation of the colon may increase the risk of pancreatitis.
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This rare complication should be considered in discussions when obtaining informed consent for the procedure.
Abstract
Introduction
Abdominal pain after colonoscopy is a relatively common symptom and usually benign. Colonoscopy-induced pancreatitis is an extremely rare phenomenon that can sometimes be missed leading to delayed diagnosis and treatment.
Presentation of case
A 53 year old woman presented to the Emergency Department with abdominal pain, a significantly raised lipase and a CT scan revealing pancreatitis. She had no previous history of pancreatitis or any aetiological risk factors. Her pain started 2 h after having a routine outpatient colonoscopy for polyp surveillance. The endoscopist had no difficulty during the procedure and the findings were unremarkable. She developed a Systemic Inflammatory Response Syndrome (SIRS) and an ileus requiring a prolonged hospital admission. However with conservative management she improved and was discharged on day 11 post-admission in stable condition.
Discussion
The mechanism of colonoscopy-induced pancreatitis is not well understood. Hypotheses include mechanical trauma to the pancreas caused by the endoscope particularly at the splenic flexure, over-insufflation of the colon, external abdominal pressure, and transmural colonic burns via electrocautery causing irritation to the pancreas.
Conclusion
Pancreatitis should be considered in the differential diagnosis of abdominal pain post-colonoscopy after the more common explanations are excluded.