Cardiopulmonary and skin examination were within normal limits. The neurologic examination was at baseline. There was mild tenderness in the right upper quadrant of the abdomen on palpation no abdominal rigidity, guarding or organomegaly was appreciated. His abdomen was non-distended with normal bowel sounds. Vital signs showed tachycardia with a heart rate of 115 beats per minute, a temperature of 99☏, blood pressure of 151/92 mmHg, and oxygen saturation of 96% on room air. On arrival to the emergency department, he was comfortable, in no apparent distress. He lived with his sister who corroborated his history. His family history was unremarkable, and he denied the use of any illicit drugs. He had undergone a left nephrectomy six years earlier for a stage one renal cell carcinoma. His other medical comorbidities included hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism. He had no associated symptoms of fever, nausea, vomiting, constipation, and diarrhea. He endorsed the onset of the pain on the eve following his procedure and denied any previous history of similar pain. No polyps were found and therefore no therapeutic interventions were performed. The patient described the pain as sharp, constant, non-radiating, and located in the epigastrium and right upper quadrant of the abdomen. During the procedure, no manual pressure or change in patient position was required. The quality of bowel preparation was suboptimal, however, the procedure was completed until the cecum without any technical difficulties. The patient had undergone a colonoscopy for colorectal cancer screening two days prior to presentation. We present our experience with two such cases.Ī 56-year-old man with cognitive delay was brought to the emergency department with abdominal pain for two days. Only a handful of cases of acute cholecystitis as an adverse event of colonoscopy have been reported thus far. Therefore, knowledge of rare adverse events such as acute cholecystitis is paramount, as prompt recognition may alter management and outcomes. With the increasing population of US adults older than 50 years of age, the number of annual screening colonoscopies has also risen (from 34% in 2000 to 63% in 2015) and is expected to increase further. Severe pain after colonoscopy may very rarely occur due to acute cholecystitis, especially with concomitant fever and abnormal liver enzymes. In such cases, one should pursue abdominal imaging, in order to rule out colonic perforation. Rarely, abdominal pain may be severe and unrelenting. Though it may have a host of etiologies, it is most commonly a result of air insufflation, endoscope looping, and/or manual pressure maneuvers used during a colonoscopy. Mild abdominal pain/discomfort immediately after a colonoscopy is not rare, occurring anywhere between 2.5% to 11% of the cases. However, with approximately more than 15 million colonoscopies being performed each year in the United States (US) alone, events such as bleeding, perforation, and mortality do occur. Colonoscopy is generally considered a safe and low-risk gastrointestinal procedure, and as such severe adverse events are rare.
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