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HOME > Ann Coloproctol > Volume 29(5); 2013 > Article
Case Report
 Acute Cholecystitis After a Colonoscopy
Tae Ik Park, Sang Yong Lee, Jun Hee Lee, Min Cheol Kim, Bong Gap Kim, Dong Hyuk Cha1
Annals of Coloproctology 2013;29(5):213-215.
DOI: https://doi.org/10.3393/ac.2013.29.5.213
Published online: October 31, 2013

Department of Internal Medicine, Ilsin Christian Hospital, Busan, Korea.

1Department of Internal Medicine, Busan St. Mary's Hospital, Busan, Korea.

Correspondence to: Sang Yong Lee, M.D. Department of Internal Medicine, Ilsin Christian Hospital, 27 Jeonggongdan-ro, Dong-gu, Busan 601-724, Korea. Tel: +82-51-630-0498, Fax: +82-51-630-0682, evergzone@nate.com
• Received: January 29, 2013   • Accepted: April 10, 2013

© 2013 The Korean Society of Coloproctology

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Acute cholecystitis after a colonoscopy is a rare event, and only eight documented cases are reported in the literature. A 35-year-old male underwent a screening colonoscopy. There was a 5-mm sessile polyp in the sigmoid colon, which was removed by using a hot snare polypectomy. Forty-eight hours after the colonoscopy, the patient visited our emergency department with epigastric pain and fever. Based on the clinical findings, laboratory data and radiologic imaging, our diagnosis was acute cholecystitis. Because no previous cases of this type have been reported to date in Korea, we publish the details of our patients who presented with a postcolonoscopy complication diagnosed as acute cholecystitis.
  • Keywords: Colonoscopy; Acute cholecystitis; Complications
Colonoscopy is a commonly performed procedure for the diagnosis and treatment of a gastrointestinal disease. Complications after a colonoscopy are rare, with perforation and hemorrhage being the most frequent [1, 2]. Acute cholecystitis after a colonoscopy is a rare event, and no case has been reported to date in Korea. We report a case of acute cholecystitis after a colonoscopy.
A 35-year-old male underwent a screening colonoscopy. A 5-mm-sized sessile polyp was noted in the sigmoid colon. After informed consent had been obtained, an uneventful hot snare polypectomy was performed. About 48 hours after the procedure, the patient visited the emergency room with epigastric pain. Physical examination revealed right upper quadrant and epigastric tenderness. The patient had a blood pressure of 150/90 mmHg, a heart rate of 105 beats/min, a respiratory rate of 22 times/min, and a body temperature of 38.5℃. Peripheral blood tests showed white blood cell, 13,300 mm2; neutrophils, 75.0%; hemoglobin, 17.0 g/dL; and platelets, 309,000 mm2. Blood biochemistry showed total bilirubin 1.7 mg/dL; serum glutamic oxalacetic transaminase, 42 IU/L; serum glutamic pyruvic transaminase, 115 IU/L; alkaline phosphatase, 263 IU/L; blood urea nitrogen, 5.9 mg/dL; creatinine, 1.1 mg/dL; and C-reactive peptide, 29.3 mg/dL.
On a plain radiograph, no intraperitoneal air was seen. Abdominal computed tomography showed a 1-cm-sized gallstone in the gallbladder neck, which had a thickened wall and pericholecystic inflammation (Fig. 1). The patient was treated with intravenous antibiotics, and his symptoms and lab findings were improved within 3 days. He was discharged 7 days after admission and was given oral antibiotics; he planned to undergo a cholecystectomy.
Complications after a colonoscopy are rare, and perforation is the most common complication of this procedure. The rate of perforation reported in large studies is 0.3% or less and is generally less than 0.1% [3]. The second most common complication is hemorrhage, and other miscellaneous complications of a colonoscopy include splenic rupture, acute appendicitis, diverticulitis, subcutaneous emphysema, and tearing of mesenteric vessels with intraabdominal hemorrhage. Acute cholecystitis after a colonoscopy was first reported by Milman and Goldenberg [4]. All patients of the 8 cases reported in the literature had uneventful routine colonoscopies and developed cholecystitis within 72 hours after the procedures. Seven of them had concurrent cholelithiasis, and all patients recovered uneventfully after a cholecystectomy. All cases reported in literature are summarized in Table 1.
Some hypotheses have been suggested in the previous literature about the cause of acute cholecystitis after a colonoscopy. The relative dehydration caused by bowel preparation may make the patients more susceptible to developing acute cholecystitis. Dehydration caused by bowel preparation may lead to bile stasis, increased bile lithogenicity, and gallbladder distention, which increase the risk of a local inflammatory reaction [4]. In this setting, a preexisting gallstone can become impacted in the gallbladder neck or in the cystic duct [5], contributing to cholecystitis. Other proposed mechanisms are mechanical manipulation associated with bacterial translocation of the colon, and trauma or an adjacent inflammatory response from a polypectomy [4, 6, 7].
Our patient had an uncomplicated, uneventful colonoscopy and developed cholecystitis 48 hours after the procedure. The patient likely had a longstanding asymptomatic gallstone that became symptomatic after the colonoscopy. Transient relative dehydration caused by bowel preparation may have made the bile more concentrated so that the preexisting stone became impacted in the gallbladder neck, leading to acute cholecystitis.
Although the reason our patient developed cholecystitis is not clear, the clinical characteristics and course of our case are correlated with those in the previous literature. While acute cholecystitis after a colonoscopy is a rare complication, we should consider cholecystitis in the differential diagnosis of postcolonoscopy abdominal pain and fever once common complications have been excluded.

No potential conflict of interest relevant to this article was reported.

  • 1. Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 2010;16:425–430. ArticlePubMedPMC
  • 2. Rabeneck L, Paszat LF, Hilsden RJ, Saskin R, Leddin D, Grunfeld E, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008;135:1899–1906. ArticlePubMed
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  • 5. Aziz F, Milman P, McNelis J. Abdominal pain after colonoscopy: can it be acute cholecystitis? Dig Dis Sci 2007;52:2660–2661. ArticlePubMed
  • 6. Fernandez-Martinez C, Pla-Marti V, Flors-Alandi C, Roig-Vila JV. Gangrenous cholecystitis after colonoscopy. Am J Gastroenterol 2002;97:1572.Article
  • 7. Maddur H, Agrawal S, Fayad N, Chalasani N, Kahi C. Acute cholecystitis after colonoscopy: a case series. Gastrointest Endosc 2011;74:211–213. ArticlePubMed
Fig. 1
Computed tomographic (CT) imaging findings. (A) Precontrast CT scan shows a gallstone in the gallbladder neck. (B) Contrast enhanced CT scan shows gallbladder wall thickening and pericholecystic inflammation.
ac-29-213-g001.jpg
Table 1
Summary of the cases
ac-29-213-i001.jpg

NR, not reported.

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • The Role of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Acute Cholecystitis After a Routine Colonoscopy: A Case Report
      Ahmad Abdulraheem, Dania Shukri, Nadera Altork, Usman Afzal, Mohammed Abu-Rumaileh, Alireza Meighani
      Cureus.2025;[Epub]     CrossRef
    • Acute cholecystitis as a complication of diverting loop ileostomy: A case series and narrative review
      Rama HG Mikhail, Konstantinos Syrrakos, Rama HG Mikhail, Konstantinos Syrrakos
      Journal of Case Reports and Images in Surgery.2023; 9(2): 16.     CrossRef
    • Acute cholecystitis following elective colonoscopy
      Kimberley Maree Neubeck, Derek Mwagiru, Eric Frederick Boseto
      BMJ Case Reports.2023; 16(11): e257166.     CrossRef
    • Colecistitis aguda tras colonoscopia: Una complicación infrecuente
      P. Ladrón Abia, A. Mínguez Sabater, M. García-Campos, F. Del Hoyo
      Revista de Gastroenterología de México.2022; 87(4): 491.     CrossRef
    • Acute cholecystitis after colonoscopy: A rare complication
      P. Ladrón Abia, A. Mínguez Sabater, M. García-Campos, F. Del Hoyo
      Revista de Gastroenterología de México (English Edition).2022; 87(4): 491.     CrossRef
    • Acute Cholecystitis, A Rare Complication Following Routine Colonoscopy: Case Series and Literature Review
      Danial H Shaikh, Kishore Kumar, Harish Patel, Shehriyar Mehershanhi, Jasbir Makker
      Cureus.2020;[Epub]     CrossRef
    • Pediatric Endoscopic Procedure Complications
      Thomas M. Attard, Anne-Marie Grima, Mike Thomson
      Current Gastroenterology Reports.2018;[Epub]     CrossRef
    • Acute Cholecystitis after Screening Colonoscopy
      Cheol Yun Jeong, Sung Hoon Jung
      Korean Journal of Pancreas and Biliary Tract.2016; 21(4): 228.     CrossRef
    • Acute Cholecystitis as a Complication After Colonoscopy: A Case Report and Literature Review
      Madalina Maria Gorgan, Ioana Grigorescu, Dan Lucian Dumitrascu
      European Journal of Case Reports in Internal Medicine.2016;[Epub]     CrossRef

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      Acute Cholecystitis After a Colonoscopy
      Ann Coloproctol. 2013;29(5):213-215.   Published online October 31, 2013
      DOI: https://doi.org/10.3393/ac.2013.29.5.213
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    Acute Cholecystitis After a Colonoscopy
    Image
    Fig. 1 Computed tomographic (CT) imaging findings. (A) Precontrast CT scan shows a gallstone in the gallbladder neck. (B) Contrast enhanced CT scan shows gallbladder wall thickening and pericholecystic inflammation.

    Fig. 1

    Acute Cholecystitis After a Colonoscopy

    Summary of the cases

    NR, not reported.
    Table 1 Summary of the cases

    NR, not reported.

    Table 1

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