Post-Polypectomy Bleeding: Causes and Next Steps - Gastroenterology and Hepatology

Colonoscopy polypectomy?

My younger sister underwent a colonoscopy due to prolonged abdominal discomfort, during which polyps were discovered and removed.
However, one day after the procedure, she experienced bleeding and required eight bags of blood (including hemoglobin).
What could be the cause of this bleeding? The doctor mentioned it was a one percent chance or just bad luck.
After the bleeding was controlled with another colonoscopy, she was discharged and continues to take medication, but she still feels unwell.
How should she seek further medical attention?

PAUL, 30~39 year old female. Ask Date: 2003/01/22

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! Colorectal polyps can be precursors to colorectal cancer, so if polyps are discovered, it is essential to remove them.
With advancements in endoscopic techniques, polypectomy can now be performed using a colonoscope, which has the advantage of not requiring general anesthesia and leaving no external wounds, thus avoiding the pain associated with surgical incisions.
However, there is a very small risk of postoperative bleeding.
Generally, the larger the polyp or the wider its base, the richer the blood supply, leading to a higher bleeding rate.
Nevertheless, bleeding can usually be controlled with endoscopic hemostasis.
After a colonoscopic polypectomy, physicians typically advise monitoring for any significant gastrointestinal bleeding and recommend consuming soft and liquid foods for several days post-procedure to avoid irritating the site and causing bleeding.
Discomfort after hemostasis is often due to intestinal gas, which can be alleviated with medication.
Best wishes for your health from Dr.
Yang Pei-Chen, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/01/22

More Info

Post-polypectomy bleeding is a known complication that can occur after the removal of polyps during a colonoscopy. While the majority of patients experience no significant issues, a small percentage may experience bleeding, which can be severe in some cases. In your sister's situation, where she experienced significant bleeding requiring multiple blood transfusions, it is essential to understand the potential causes and the appropriate next steps for her recovery.

Causes of Post-Polypectomy Bleeding
1. Vascular Injury: During the polypectomy, blood vessels within or around the polyp may be inadvertently cut or damaged. If these vessels are large or if the polyp was particularly vascular, this can lead to significant bleeding.

2. Coagulation Issues: If the patient has underlying coagulation disorders or is on anticoagulant medications, this can increase the risk of bleeding. It is crucial to review her medical history to determine if any such factors were present.

3. Incomplete Removal: Sometimes, if the polyp is not completely removed, the remaining tissue can bleed. This is particularly true for larger polyps or those with dysplastic changes.

4. Infection or Inflammation: Post-procedure infections or inflammatory responses can also contribute to bleeding. Although less common, it is a possibility that should be considered, especially if there are signs of infection.

5. Technical Factors: The technique used during the polypectomy can also influence the risk of bleeding. For instance, the use of electrocautery can sometimes lead to delayed bleeding if the coagulation is not adequate.

Next Steps for Management
1. Follow-Up with Gastroenterologist: Given the severity of the bleeding, it is crucial for your sister to have a follow-up appointment with her gastroenterologist. They may recommend additional imaging or endoscopic evaluation to ensure that there are no remaining polyps or other sources of bleeding.

2. Monitoring Symptoms: Your sister should monitor her symptoms closely. If she experiences any signs of recurrent bleeding, such as passing blood in her stool, dizziness, or increased abdominal pain, she should seek immediate medical attention.

3. Medication Review: It is important to review any medications she is taking, especially anticoagulants or non-steroidal anti-inflammatory drugs (NSAIDs), as these can exacerbate bleeding. Her doctor may need to adjust her medications accordingly.

4. Dietary Considerations: After a polypectomy, a low-fiber diet may be recommended initially to minimize bowel movements and reduce strain. Gradually reintroducing fiber can help with recovery, but this should be done under medical guidance.

5. Hydration and Rest: Ensuring adequate hydration and rest is vital for recovery. This can help her body heal and may alleviate some discomfort.

6. Potential for Further Procedures: If bleeding persists or if there are complications, further endoscopic interventions may be necessary. This could include cauterization of the bleeding site or even surgical intervention in rare cases.

Conclusion
While post-polypectomy bleeding can be alarming, it is essential to approach the situation with a clear understanding of the potential causes and the necessary steps for management. Your sister's experience, while unfortunate, is within the realm of possible complications. Continued communication with her healthcare providers, monitoring her symptoms, and adhering to follow-up appointments will be crucial in ensuring her recovery and addressing any ongoing discomfort. If her symptoms persist or worsen, seeking a second opinion or further evaluation may be warranted to ensure comprehensive care.

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