A nurse assigned to the emergency department evaluates a patient who underwent fiberoptic colonoscopy 18 hours previously. The patient reports increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern?
A. Bowel perforation
B. Viral Gastroenteritis
C. Colon cancer
D. Diverticulitis
Correct Answer: A. Bowel perforation
Bowel perforation is the most serious complication of fiberoptic colonoscopy. Important signs include progressive abdominal pain, fever, chills, and tachycardia, which indicate advancing peritonitis. One of the most serious complications of colonoscopy is endoscopic perforation of the colon, which has been reported as between 0.03% and 0.7%. Although colonoscopic perforation (CP) occurs rarely, it can be associated with high mortality and morbidity rates.
Option B: Viral gastroenteritis is a known cause of nausea, vomiting, diarrhea, anorexia, weight loss, and dehydration. Isolated cases can occur, but viral gastroenteritis more commonly occurs in outbreaks within close communities such as daycare centers, nursing facilities, and cruise ships. Many different viruses can lead to symptomatology, though in routine clinical practice the true causative virus is generally not identified.
Option C: If the patient is age 50 or older and at average risk of colon cancer — he has no colon cancer risk factors other than age — the doctor may recommend a colonoscopy every 10 years or sometimes sooner to screen for colon cancer. Colonoscopy is one option for colon cancer screening.
Option D: Diverticulitis may cause pain, fever, and chills, but is far less serious than perforation and peritonitis.