First case of paralytic ileus after endoscopic mucosal resection of caecal polyp

Zubair Khan; Umar Darr; Mohammad Saud Khan; Mohamad Nawras; Ehsan Rafiq; Ali Nawras

doi:10.1016/j.ajg.2020.04.009

First case of paralytic ileus after endoscopic mucosal resection of caecal polyp

Arab J Gastroenterol. 2020 Jun;21(2):117-121. doi: 10.1016/j.ajg.2020.04.009. Epub 2020 May 15.

Authors

Zubair Khan¹, Umar Darr², Mohammad Saud Khan², Mohamad Nawras², Ehsan Rafiq², Ali Nawras²

Affiliations

¹ University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States. Electronic address: zubair.khan@utoledo.edu.
² University of Toledo Medical Center, Department of Internal Medicine, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States; Division of Gastroenterology, University of Toledo, 3000 Arlington Avenue, MS 1150, Toledo, OH 43614, United States.

PMID: 32423855
DOI: 10.1016/j.ajg.2020.04.009

Abstract

Endoscopic mucosal resection (EMR) is a technique developed for the removal of sessile or flat neoplastic lesions confined to the superficial layers (mucosa and submucosa) of the gastrointestinal tract. Bleeding and perforation are well-known complications of EMR. Here we report the first case of paralytic ileus after EMR of a caecal polyp. A 66-year-old man was scheduled for elective EMR of a 3.5-cm caecal polyp under general anaesthesia after a screening colonoscopy. The procedure was performed by an expert endoscopist, and air was insufflated during the procedure because of the unavailability of CO₂. The polyp was successfully removed; the procedure duration was 81 min. After the procedure, the patient complained of abdominal pain and dyspnoea. He developed tachypnoea and tachycardia as well as oxygen desaturation with SpO₂ 84%. He was administered oxygen therapy via a non-rebreather mask, following which his oxygenation improved. His abdominal X-ray findings were consistent with ileus. Therefore, a nasogastric tube was placed, and the patient was admitted to our hospital. He was managed conservatively and underwent serial abdominal X-rays that showed improvement of the ileus. On the fourth day of admission, he was started on an oral diet; on the sixth day of admission, he was discharged with resolving ileus. Computed tomography enterography performed 1 week after discharge showed complete resolution of the ileus. Factors that may have contributed to the occurrence of ileus in our patient include the use of air during the procedure, location of the polyp (caecal), duration of the procedure, effect of electrocautery, use of general anaesthesia and possibility of aspiration pneumonitis. This case report will make endoscopists aware of the abovementioned factors while performing EMR as this procedure can lead to the complication of paralytic ileus with significant patient morbidity. Conservative treatment should be attempted first before any other intervention.

Keywords: Caecal polyp; Colonic polyp; Endoscopic mucosal resection; Mucosal resection; Therapeutic endoscopy.

Publication types

Case Reports

MeSH terms

Aged
Cecum* / diagnostic imaging
Cecum* / surgery
Colonic Polyps* / diagnosis
Colonic Polyps* / surgery
Colonoscopy / methods
Conservative Treatment / methods
Endoscopic Mucosal Resection* / adverse effects
Endoscopic Mucosal Resection* / methods
Humans
Intestinal Mucosa / pathology
Intestinal Mucosa / surgery
Intestinal Pseudo-Obstruction* / diagnosis
Intestinal Pseudo-Obstruction* / etiology
Intestinal Pseudo-Obstruction* / physiopathology
Intestinal Pseudo-Obstruction* / therapy
Intubation, Gastrointestinal / methods
Male
Oxygen Inhalation Therapy
Postoperative Complications* / diagnosis
Postoperative Complications* / physiopathology
Postoperative Complications* / therapy
Radiography, Abdominal / methods
Treatment Outcome