Postpolypectomy Electrocoagulation Syndrome: A Mimicker of Colonic Perforation

Postpolypectomy electrocoagulation syndrome is a rare complication of polypectomy with electrocautery and is characterized by a transmural burn of the colon wall. Patients typically present within 12 hours after the procedure with symptoms mimicking colonic perforation. Presented is the case of a 56-year-old man who developed abdominal pain six hours after colonoscopy during which polypectomy was performed using snare cautery. CT imaging of the abdomen revealed circumferential thickening of the wall of the transverse colon without evidence of free air. The patient was treated conservatively as an outpatient and had resolution of his pain over the following four days. Recognition of the diagnosis and understanding of the treatment are important to avoid unnecessary exploratory laparotomy or hospitalization. 1. Introduction Postpolypectomy electrocoagulation syndrome (also known as postpolypectomy syndrome or transmural burn syndrome) is characterized by peritoneal inflammation in the absence of frank perforation occurring after polypectomy with electrocautery. It is a rare complication of polypectomy and occurs when electrical current applied during polypectomy extends into the muscularis propria and serosa resulting in a transmural burn at the site of polypectomy. Patients typically present with abdominal pain and tenderness hours to days after the procedure but may also have fever, tachycardia, and leukocytosis; their presentation often mimics colonic perforation. Recognition of the diagnosis and understanding of the treatment is important to avoid unnecessary exploratory laparotomy or hospitalization. 2. Case Report A 56-year-old man underwent a colonoscopy for initial colorectal cancer screening, revealing an 8？mm transverse colon polyp (Figure 1) which was removed with snare cautery and a 6？mm transverse colon polyp that was removed with a cold snare. The evening after the procedure, he presented to the emergency department complaining of acute onset of diffuse, sharp abdominal pain beginning approximately six hours after his colonoscopy. He reported one episode of nonbloody diarrhea shortly after his colonoscopy but had no symptoms of nausea or vomiting. He was found to be afebrile and had normal vital signs. Physical exam was notable for moderate right lower quadrant abdominal tenderness without peritoneal signs or rebound tenderness. Laboratory studies were significant for a leukocytosis of 18.0 109/L with 87% granulocytes; chemistries and hepatic function studies were within normal limits. A plain film of the abdomen was normal. A CT scan of the