Colonoscopy complicated by arterial avulsion and retroperitoneal hemorrhage
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Bibliographic record
Abstract
A 77-year-old woman with a past surgical history of hysterectomy presented to the Emergency Department with increasing lower abdominal and back pain. A routine screening colonoscopy had been performed 8 hours previously; the endoscopist had noted that the colon was tortuous, however no abnormality had been seen. Abdominal palpation demonstrated moderate generalized lower abdominal tenderness. Her white blood cell count (WBC) was found to be elevated at 24 10 9 /L. An urgent computed tomography (CT) scan revealed a fluid density mass in the pelvis ( " Fig. The spleen and liver were normal, and no free air was visualized. Laparotomy revealed a large retroperitoneal and retrorectal hematoma with only minimal blood in the abdomen. Adhesions between the colon and vaginal vault gave the rectosigmoid a tight S-shape, and a segment approximately 10 cm in length was ischemic. A branch of the superior rectal artery that had been avulsed could be identified. It is likely that during her colonoscopy, in the process of getting the 'tight S' into a shape that the colonoscope could navigate, the artery gave way as it had less resistance than the tight adhesions. Hartman's procedure was performed. The most common complications of colonoscopy include hemorrhage (0.2 % -0.5 %) and perforation (0.9 % -0.1 %) The presence of fluid in the pelvis on CT scanning could make one think of a perforation; however, the lack of free air would make a perforation unlikely and hemorrhage more likely. Our patient remained hemodynamically stable because the bleeding remained retroperitoneal, which provided some degree of tamponade. The scenario of a patient presenting to the emergency department after colonoscopy, particularly with abdominal tenderness, should make one very suspicious of a complication.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it