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Case Reports in Surgery
Volume 2013 (2013), Article ID 695318, 3 pages
http://dx.doi.org/10.1155/2013/695318
Case Report

Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy

Department of Surgery, University of Alberta, 2000 College Plaza, 8215 112th Street, Edmonton, AB, Canada T6G 2C8

Received 19 May 2013; Accepted 19 July 2013

Academic Editors: S. K. Boolbol and M. Ganau

Copyright © 2013 Oliver J. Ziff and A. M. James Shapiro. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Colonoscopy is widely accepted as the gold-standard screening technique for detecting malignancies in the distal gastrointestinal tract in patients with symptoms suggestive of colon cancer. However, this procedure is not without risk, including colonic perforation. We report a patient who was managed conservatively after colonoscopy induced perforation. Eighteen months after appearing to make a full recovery, he presented with an upper gastrointestinal bleed. Oesophago-gastro-duodenoscopy (OGD) revealed large gastric fundal varices and computed tomography (CT) revealed splenic vein thrombosis. The ensuing left-sided (sinistral) hypertension explains the development of the fundal varices in the presence of normal liver function. At surgery, a persistent abscess cavity was identified and cultures from this site grew Streptococcus anginosus. Curative splenectomy was performed and the patient made a full recovery. We advocate more prompt operative intervention in selected cases of iatrogenic colonic perforation with primary repair to prevent late complications.