Patient Develops Dangerous Rectal Bleeding Following Colonoscopy

Case Overview

This case involves a 71-year-old male patient who visited a gastroenterologist for a routine colonoscopy. During the colonoscopy, a large sessile serrated lesion was found. The patient received a hot snare polypectomy procedure for treatment of the lesion and was subsequently discharged. Post-operatively, at home, the patient developed rectal bleeding which caused him to faint. The patient fell backward, causing severe hip injuries as well as a traumatic brain injury. The patient was taken for emergency surgery for his traumatic brain injury but died post-operatively.

Questions to the Gastroenterology expert and their responses

How often do you perform colonoscopies?

I perform about 15 colonoscopies per week.

How often do you perform hot snare polypectomy procedures?

I perform hot snare polypectomy procedures several times per week as well, as it is a very common modality for removing polyps.

What should be done to prevent sending a patient home with rectal bleeding?

Post-polypectomy bleeding is a known complication of a colonoscopy with polypectomy. This risk should be discussed in the process of obtaining consent. There are several ways to minimize the risk of bleeding. These include identifying who is at risk for bleeding, using the cold snare technique for smaller polyps (less than 1cm), holding anti-platelet/anti-coagulation medication before and/or after the procedure, treating active bleeding during the procedure, and empirically placing hemostatic clips on post-polypectomy sites, among others.

About the expert

This expert has nearly 10 years of experience in the field of gastroenterology. He earned his BS in biology from the University of Michigan and his MD from Northwestern University School of Medicine. After completing a residency in internal medicine at Northwestern University, he went on to complete a fellowship in clinical nutrition at the University of Chicago and a second fellowship in gastroenterology at Rush University Medical Center. Today, this expert is board certified in gastroenterology and is active in his field as a member of the American Gastroenterology Association, the American Society of Nutrition, and the American Society of Gastrointestinal Endoscopy. Currently, he is the associate director of adult clinical nutrition, an associate professor of gastroenterology, and the co-director of the obesity program at a top university in Illinois.