Acute lower gastrointestinal bleeding from a polyp

A 50-year-old woman was admitted to our institution because of a pertrochanteric fracture in her right hip to place a femoral nail. Orthopedic surgeons prescribed metamizol 1 g t.i.d. plus paracetamol 1 g t.i.d., both intravenously, as analgesics. One week after surgery she started having hematochezia and her hemoglobin dropped from 12 to 7.7 g/dL. She underwent an urgent gastroscopy (normal)and a colonoscopy, which revealed active bleeding from a sessile polyp (10 mm in diameter), located 30 cm from the anal margin (Fig. 1). At this stage we performed a snare polypectomy after submucosal injection of saline plus adrenaline and finally we performed a prophylactic clipping of the resection site (Fig. 2). Histology demonstrated a tubular adenoma with low-grade dysplasia.

Figure 1

Adenomatous polyp with active bleeding

Figure 2

Hemoclip placed after polypectomy

Polyps typically result in chronic blood loss and are the source of acute lower gastrointestinal bleeding in only a small percentage of patients [1]. Risk factors for bleeding include polyp size greater than 10 mm, presence of a stalk, and cherry-red color [2]; associated histopathological findings include marked vascular congestion and intramucosal lakes of blood [3]. While clinically relevant, bleeding occurs in 1-6% of patients undergoing colonoscopic polypectomy.