UCTN – Unusual cases and technical notes E93

Hemoperitoneum caused by hemorrhage of tubal vessels, a previously undescribed complication of colonoscopy

A 46-year-old woman underwent colo- References noscopy due to iron-deficiency anemia. 1 Ko CW, Riffle S, Michaels L et al. Serious com- The patient had previously undergone an plications within 30 days of screening and surveillance colonoscopy are uncommon. operation for ovarian endometriomas. Clin Gastroenterol Hepatol 2010; 8: 166– During this procedure, when the operator 173 [Epub 2009 Oct 20] was advancing with the endoscope to the 2 Tagg W, Woods S, Razdan R et al. Hemoperi- sigmoid colon, the patient suddenly suf- toneum after colonoscopy. Endoscopy 2008; – fered a severe abdominal pain. The ex- 40: E136 E137 [Epub 2008 Jul 16] 3 Sorrentino M, Terrosu G, Risaliti A et al. He- ploration was suspended before perfora- moperitoneum caused by lesions to the ap- tion was suspected. pendix epiploica. An unusual complication Physical examination revealed hypogas- of colonoscopy. Minerva Chir 1996; 51: tric abdominal pain with peritoneal irrita- 835– 837 4 Gonzalez-Rodriguez JF, Tarquis-Alonso P, Cas- tion. The laboratory test was negative, and tano-Pascual A, Gonzalez-Lera S. Hemoperi- the abdominal radiograph excluded toneum due to necrosis of a small intestinal (●" Fig. 1). leiomyosarcoma following colonoscopy. En- The patient presented for clinical exami- doscopy 1993; 25: 253– 254 nation of acute abdominal pain, so it was 5 Fusaroli P, Maltoni S, Eusebi V et al. Ovarian tumor rupture causing massive hemoperi- decided to make an emergency laparoto- toneum: an unusual complication of colo- my. During this operation, hemoperito- Fig. 1 Abdominal radiograph that excludes noscopy. Gastrointest Endosc 2008; 67: neum was found (150 mL of ), two pneumoperitoneum. 1177– 1178 [Epub 2008 Apr 18] ruptures on the serosa of the sigma with no alteration on the mucosa and submu- Bibliography cosa were visualized, and tubal vessel ovarian tumor rupture [5]. As far as we DOI 10.1055/s-0030-1256025 hemorrhage and adherences between the know, this is the first case of hemoperito- Endoscopy 2011; 43: E93 mesosalpinx and mesosigma observed. neum caused by rupture of tubal vessels © Georg Thieme Verlag KG Stuttgart · New York · ISSN 0013-726X The incidence of serious complications with adherences of the fallopian tube to due to colonoscopy is low; the percentage the sigma. Corresponding author of procedures for which complications re- N. Alcaide, MD quire hospitalization is 0.21 %. Serious Endoscopy_UCTN_Code_CPL_1AJ_2AB Deparment of complications may be associated with Hospital Universitario Río Hortega stricture dilation, polypectomy, elderly Competing interests: None C/Dulzaina 2 patients or inexperienced endoscopists 47012 Valladolid [1]. Hemoperitoneum is an uncommon N. Alcaide1, R. Atienza1, J. Barrio1, Spain complication of colonoscopy [2]. The C. de la Cuesta2, M. Pérez-Miranda1 Fax: +34-983-420400 [email protected] most frequent cause of hemoperitoneum 1 Department of Gastroenterology, is splenic injury, but in the literature there University Hospital Río Hortega, are others causes described, such as rup- Valladolid, Spain ture of an epiploic [3], torsion 2 Department of Gastrointestinal Surgery, of the mesenteric vein [2], necrosis of a University Hospital Río Hortega, This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. small intestinal leiomyosarcoma [4] or Valladolid, Spain

Alcaide N et al. Hemoperitoneum caused by tubal vessel hemorrhage … Endoscopy 2011; 43: E93