Acute paraplegia caused by thromboembolism from an infrarenal abdominal aortic aneurysm following colonoscopy

Sep 30, 2026

Unique clinical case report describing an extremely rare but potentially fatal complication: acute bilateral lower-limb paralysis after colonoscopy. The patient, a 67-year-old man, developed sudden paraplegia and sensory loss shortly after the procedure. Computed tomography angiography confirmed acute thromboembolism associated with an infrarenal abdominal aortic aneurysm. Emergency revascularization with aorto-bifemoral bypass and thrombectomy was performed, yet death occurred from massive reperfusion injury. The report highlights the need for prompt recognition and suggests mechanisms such as periprocedural hemodynamic changes and dehydration.

LanguageEnglish

CategoryHealthcare

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Pages4

Reading Time10 min

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Introduction

Case presentation

® Clinical Case Report Acute paraplegia caused by thromboembolism from an infrarenal abdominal aortic aneurysm following colonoscopy Il Soon Jung, MDa ,b ,* | Abstract
Rationale: Colonoscopy is a widely used diagnostic and therapeutic procedure with a low risk of serious adverse events. Acute bilateral lower-limb paralysis following colonoscopy is extremely rare. Acute limb ischemia due to thromboembolism from abdominal aortic aneurysm (AAA) is a vascular emergency that requires prompt diagnosis and intervention. This is the report of a unique case of acute limb ischemia due to thromboembolism associated with infrarenal AAA following colonoscopy. This case report aims to raise clinical awareness of the potential risk of thromboembolic complications after colonoscopy. Further, this case suggests a potential mechanism in which hemodynamic alterations or periprocedural factors, such as dehydration associated with bowel preparation, may have contributed to thrombus dislodgement and subsequent embolization.
Patient concerns: A 67-year-old man with acute paraplegia was referred to our emergency department following colonoscopy. Diagnoses: The patient was diagnosed with acute thromboembolism associated with an infrarenal AAA, resulting in paraplegia following colonoscopy, as confirmed by computed tomography angiography.
Interventions: The patient underwent emergent aorto-bifemoral bypass, bilateral lower extremity thrombectomy, and left femoral artery-to-distal superficial femoral artery bypass surgery.
Outcomes: Although revascularization was technically successful, the patient died of massive reperfusion injury.
Lessons: Acute paraplegia caused by thromboembolism from an infrarenal AAA following colonoscopy is extremely rare but potentially fatal. Awareness of this potential adverse event after colonoscopy is critical to avoid severe outcomes and improve patient prognoses.
Abbreviations: AAA = abdominal aortic aneurysm, CTA = computed tomography angiography. | | --- | | Keywords: abdominal aortic aneurysm, adverse event, colonoscopy, paraplegia, thromboembolism | 1. Introduction Colonoscopy is one of the most widely used diagnostic methods worldwide for the screening, diagnosis, and treatment of colorectal diseases. Colonoscopy is considered a relatively low-risk procedure; however, various complications have been reported in approximately 2.8 cases per 1000 procedures.[1] The incidence rate of serious complications was reported to be a low 0.28% ina systematic analysis of 12 articles that involved 57,742 individuals who underwent screening colonoscopy.[2] Overall, procedure related mortality has been reported to be as low as 0.09% . [1] To the best of my knowledge, unexpected thromboembolism of an infrarenal abdominal aortic aneurysm (AAA) (not Informed consent was waived by the IRB due to the retrospective nature of the case report. The author has no funding and conflicts of interest to disclose. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. This study followed the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Chungbuk National University Hospital with a waiver of informed consent (IRB No. CBNUH 2025-06-017). a Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea, b Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea. * Correspondence: Il Soon Jung, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, previously diagnosed) following colonoscopy has not been described in the scientific literature. This is the 1st report of a case of acute paraplegia due to thromboembolism associated with an infrarenal AAA following colonoscopy. 2. Case presentation A 67-year-old man with acute-onset parap

FAQs

How soon after colonoscopy did the patient develop paraplegia?

He developed acute-onset paraplegia within about 1 hour of awakening from sedation after colonoscopy.

What diagnostic method confirmed the underlying cause?

Computed tomography angiography confirmed acute thromboembolism associated with an infrarenal abdominal aortic aneurysm.

What treatment was performed and what was the outcome?

The patient underwent emergent aorto-bifemoral bypass, bilateral lower extremity thrombectomy, and additional bypass surgery. Despite technically successful revascularization, he died of massive reperfusion injury.

Sep 30, 2026

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