Peri-colonic haematoma following routine colonoscopy

INTRODUCTION: We present a case of an extra-luminal haematoma following routine colonoscopy. This case highlights an uncommon but potentially life threatening complication in which there is little published literature to date. PRESENTATION OF CASE: A 73 year old male presented with abdominal pain and a reduction in haemoglobin following an uneventful colonoscopy. The imaging had been required as part of colorectal cancer follow up. Initial differential diagnosis included colonic perforation and the patient was admitted for further investigations. Same day CT scan imaging revealed an extra-luminal haematoma in the mid descending colon. The patient was managed non-operatively and was discharged with antibiotics following a period of observation. DISCUSSION: Colonoscopy is a highly effective imaging modality for direct visualisation of the lower gastrointestinal tract and for simultaneous diagnostic or therapeutic interventions. In recent years the use of colonoscopy has increased greatly, this is largely due to an increasingly aging population, increased availability of the resource and as a consequence of the implementation of the Bowel Cancer Screening Programme. Extra-colonic bleeding following colonoscopy is rare. Causes that have been identified in the literature include splenic injury, mesenteric tears, hepatic injury and retroperitoneal haemorrhage. To the authors' knowledge, there is very little published literature specifically on isolated peri-colonic haematomas following colonoscopy. CONCLUSION: This case highlights an unusual but potentially life threatening complication following colonoscopy. Endoscopists and clinicians should be aware of the diagnosis to allow for early recognition and appropriate management.