Colonoscopy complicated by arterial avulsion and retroperitoneal hemorrhage
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. 1 ]) and thickening of the sigmoid colon ([ Fig. 2 ]). The spleen and liver were normal, and no free air was visualized. Fig. 1 Computed tomography (CT) scan demonstrating significant retroperitoneal pelvic fluid without obvious extension into the peritoneal cavity. Fig. 2 Computed tomography (CT) scan showing thick-walled rectosigmoid colon. Intraoperatively, there was an area of full-thickness ischemic necrosis. 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 %) [ 1 ] [ 2 ]. 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. Endoscopy_UCTN_Code_CPL_1AJ_2AB
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".