ABSTRACT
Objetivo: colite isquêmica após colonoscopia é evento raro. Vamos relatar dois pacientes que tiveram esta evolução. Apresentação - Caso 1: paciente do sexo feminino, 67 anos de idade, DPOC compensado, foi submetida à colonoscopia para prevenção de CCR. Tinha relato de cirurgia pélvica prévia, o preparo de cólon estava bom, os parâmetros fisiológicos permaneceram normais durante procedimento, que foi longo, difícil e com grande distensão gasosa. Seis horas após a alta hospitalar sem eventualidade, iniciou sangramento vivo pelo ânus, que evoluiu com dor abdominal agravada 20 horas após. Abdome flácido, porém doloroso à palpação profunda no quadrante inferior esquerdo. CT abdominal mostrou espessamento de parede do reto e do sigmoide e coágulos em seu interior. Evoluiu bem com tratamento conservador. Caso 2: paciente do sexo feminino, 82 anos de idade foi submetida à colonoscopia para procura de tumor sincrônico em pré-operatório de adenocarcinoma de sigmoide. Mucosectomia de adenoma plano de sigmoide foi realizada, seguida de tatuagem com nanquim acima e abaixo da lesão neoplásica no sigmoide. Procedimento realizado sem eventualidade, embora, ao cabo de 3 horas, tenha evoluído com dor, distensão abdominal e suboclusão em nível do tumor primário, confirmada por rotina radiológica. Admitida ao hospital, tratada de forma conservadora sem, no entanto, descompressão colônica. Evoluiu em 20 horas com sinais de irritação peritoneal e laparotomia exploradora, e mostrou se tratar de colite isquêmica confirmada em hemicolectomia direita. Conclusão: para evitarmos colite isquêmica após colonoscopia, o paciente deverá ter alta com o mínimo de distensão possível após o procedimento.
Introduction: ischemic colitis following colonoscopy is rare. We report two cases after uneventful colonoscopy. Presentation - Case 1: a 67 year old white female with COPD was submitted to screening colonoscopy. She had a previous pelvic surgery. The bowel was well prepared. The blood pressure was kept normal during the procedure that was difficult, time consuming with hyperinflation. Beside this, she was discharged without complain. Six hour later she started to pass bright red blood from the rectum and complaining of abdomen pain that got worse 20 hour later. At this time, the abdomen was soft to palpation with tenderness on the left lower quadrant of the abdomen. Computed tomography (CT) scans showed diffuse wall thickness of the sigmoid and the rectum with blood clot inside the lumen. High Protein C reactive was observed. She had uneventful recovery 5 days after a conservative treatment. Case 2: a 82 year old white female with an adenocarcinoma of the sigmoid colon was submitted to a colonoscopy to rule out a synchroid tumor. We performed an endoscopic mucosal resection for a benign lesion of the cecum. A tatoo close to a sigmoid tumor was done to facilitate surgery. The procedure was uneventful and she was discharged without complain. Three hours later she was distressed with abdominal distension and pain. The abdomen was soft and the bowel sounds were hyperactive. She underwent a routine chest and abdominal X ray that disclosed only hyperdistension and no free air. Twenty hours later she got worse with clinical sings of peritonitis. Right hemicolectomy was performed for ischemic colitis. Conclusion: we describe an Ischemic coliti following an uneventful colonoscopies. Both patients had reduced blood flow with damage to microvasculature probably due to a high intra luminal pressure related to hyperinflation. On the first case the cause was the long procedure time and in the second a partial colonic obstruction due to a sigmoid tumor. As a risk factor we found only a previous abdominal surgery on the first case. It is important to pay attention to a colonoscopic procedure time, hyperinflation and hyperextension. We always should leave the patient with the least possible amount of gas.