University of Connecticut Health Center Farmington, CT, United States
Samantha McPeck, MD, Jennifer Onwochei, MD, Steven Goldenberg, MD University of Connecticut Health Center, Farmington, CT
Introduction: Colonoscopy is a key tool of gastroenterologists, with crucial roles in screening, diagnosis, and treatment of lower gastrointestinal symptoms. As the utility of colonoscopy increases, it is integral to monitor and manage complications to both provide the highest level of individual care and as an indicator of quality at a broader level. We present a unique case of post-colonoscopy cholecystitis, a rare, but increasingly reported phenomenon.
Case Description/Methods: A 43-year-old female with a history of breast cancer underwent her first screening colonoscopy due to a history of CHEK2 mutation. Two polyps in the transverse and sigmoid colon were excised during the procedure, which was otherwise unremarkable with no immediate complications. The patient then presented to the ED within twenty-four hours with sudden onset sharp, crampy, diffuse abdominal pain with nausea and emesis. A CT scan of the abdomen was acquired to rule out perforation which instead demonstrated a thick-walled gallbladder with partially calcified gallstones and a normal caliber CBD. Liver chemistries and ultrasound were unremarkable and therefore a HIDA scan was performed. This demonstrated nonvisualization of the gallbladder, consistent with cystic duct obstruction and acute cholecystitis. The patient received antibiotics and underwent an uncomplicated laparoscopic cholecystectomy with resolution of symptoms.
Discussion: There are fourteen reported cases of post colonoscopy cholecystitis in the literature between 2001-2020. It remains unclear if the relationship between the two events is coincidental or causal. Several theories have been proposed to explain an association between colonoscopy and the development of acute cholecystitis. Dehydration secondary to bowel preparation may increase the lithogenicity of bile leading to stasis and obstruction. Intraprocedural manipulation of gastrointestinal organs may increase the risk of existing gallstones impacting in the gallbladder neck or contribute to bacterial translocation. Polypectomy may cause a local inflammatory response around the gallbladder. Though it is fundamental to rule out more common or serious events known to occur after colonoscopy, it is important to consider potential rare complications. Patients may present with normal liver chemistries and non-localizing abdominal pain, as in our patient and several others described in literature. An awareness of this potentially associated event is essential in order to pursue appropriate imaging studies.
Figure: Figure 1. HIDA scan demonstrates nonvisualization of the gallbladder at 90 minutes.
Samantha McPeck indicated no relevant financial relationships.
Jennifer Onwochei indicated no relevant financial relationships.
Steven Goldenberg indicated no relevant financial relationships.
Samantha McPeck, MD, Jennifer Onwochei, MD, Steven Goldenberg, MD. P0047 - Post Colonoscopy Cholecystitis: A Coincidence or a Complication?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.