During the initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate:
A. Ischemic bowel
B. Peritonitis
C. Hypovolemic shock
D. Perforated bowel
Correct Answer: D. Perforated bowel
Invasive diagnostic testing can cause perforated bowel. Perforation is widely recognized as one of the most serious complications of endoscopy of the lower gastrointestinal tract. The risk of perforation ranges from 0.027% to 0.088% for flexible sigmoidoscopy, from 0.016% to 0.2% for diagnostic colonoscopy, and up to 5% for therapeutic endoscopy.
Option A: Ischemic bowel is usually not related. As the volume of both diagnostic and therapeutic endoscopic procedures increases, the absolute number of perforations will undoubtedly increase even with a relatively constant perforation rate.
Option B: Peritonitis can be a complication after initial perforation. The risk factors contributing to perforation are well established in the literature. They include patient-related factors such as advanced age, female sex, diverticular disease, previous abdominal surgery, and colonic stricture in addition to therapeutic procedures such as endoscopic resection and dilation.
Option C: Hypovolemic shock can occur if peritonitis is allowed to continue. If the peritoneum is weakened or injured, inflammation and infection can spread through the peritoneal cavity. Peristaltic action decreases, leading to bowel obstruction. Large amounts of fluid from the intravascular space move into the peritoneal cavity, causing hypovolemia and hemoconcentration.
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