I would not consider it normal. Unless he had been fasting a long time or had serious sedation, it should be "business as usual" after the scope.

Hopefully, it is just trapped gas (they can pump a lot in there sometimes). But, if the pain is serious, you should call the doctor back or the ER, if the clinic is closed. It is rare, but sometimes there can be a perforation.

I hope by now that things are working again...

Jan

I've taken care of two patients who were perforated during a scope. Please keep an eye on him, it's nothing to mess around with. Hopefully it's gas like Jan mentioned... but honestly, if it worsens, take him to the ED.

Rachel, did you ever have a patient who perforated during a *pouchoscopy*? That would be surprising to me (at least in competent hands). It certainly can happen during a colonoscopy, especially if the colon is in bad shape.

Perforation is a risk for any type of endoscopy, even in the best of hands. All it takes is a thin area, like an ulcerated spot. Plus, the ileum is thinner than the colon. Still, perforations during endoscopy are pretty rare.

Jan

These patients who perforated came from smaller hospitals to us to "fix," and they were siiiick. Any scope procedure runs that risk, though like Jan said, it's rare.

The patients were not J pouchers. However, we're just as much at risk, though low and rare, for that complication.

I mostly agree. Heck, folks need to be attentive to symptoms of perforation even if they haven't had a procedure at all, since it can occur spontaneously. Nevertheless, the pressure on the bowel wall during a pouchoscopy is very slight, compared with the pushing needed to advance a colonoscope to the cecum. The likelihood of a perforation is small in either case, but I believe much smaller for a pouchoscopy.

Statistics are easy to misunderstand. Rare events do occur, and if we are inattentive or dismiss them then they can lead to bigger problems. There's a fine line between appropriate reassurance and inappropriate dismissal of a potential concern, and *I'd* rather get advice from Jan than from me.

Yeah, the thing is that perforation is not necessarily a big "event" with stabbing pain or something obvious that you might expect. I've seen people with a ruptured gallbladder or appendix have nothing more than a little cramping and a low grade fever.

When the gut stops working after a minor invadive procedure, I get suspicious....

Jan