Are fever and chills normal after a colonoscopy?

Fever and Chills After Colonoscopy: Normal or Concerning?

Fever and chills are not normal after colonoscopy and should prompt immediate medical attention as they may indicate a serious complication such as perforation or infection. 1

Understanding Post-Colonoscopy Complications

Colonoscopy is generally a safe procedure, but it does carry risks of complications that can manifest with symptoms including fever and chills. According to guidelines, most complications occur within the first 48 hours following the procedure, with symptoms typically developing within 48 hours of colonoscopy completion in 91-92% of patients 1.

Common Post-Colonoscopy Complications:

1. Iatrogenic Colonoscopy Perforation (ICP)

   • Presents with fever (38% of cases), abdominal pain (74-95%), and tenderness 1
   • May be accompanied by tachycardia (62.5%), leukocytosis (40%), and guarding/rebound tenderness (82.5%) 1

2. Post-Colonoscopy Infections

   • Infection rates within 7 days are approximately:
     • 1.1 per 1000 for screening colonoscopy
     • 1.6 per 1000 for non-screening colonoscopy 2

3. Other Serious Complications

   • Perforation (0.19 per 1000 exams)
   • Diverticulitis requiring hospitalization (0.23 per 1000 exams)
   • Post-polypectomy syndrome (0.09 per 1000 exams) 3
   • Acute colitis (rare but can present with systemic symptoms) 4

When to Seek Medical Attention

If you experience fever and chills after colonoscopy, you should:

1. Contact your healthcare provider immediately or seek emergency care - These symptoms may indicate a serious complication requiring prompt evaluation 1

2. Watch for accompanying symptoms that may suggest perforation or infection:

   • Severe or worsening abdominal pain
   • Abdominal distension
   • Rectal bleeding
   • Vomiting
   • Signs of peritonitis (rigid abdomen, rebound tenderness) 1

Diagnostic Approach for Post-Colonoscopy Fever

If you develop fever after colonoscopy, your healthcare provider should perform:

1. Laboratory tests including:

   • White blood cell count (WBC)
   • C-reactive protein (CRP)
   • Procalcitonin (PCT) if presentation is delayed >12 hours 1

2. Imaging studies:

   • CT scan (most accurate tool for diagnosing perforation)
   • Plain abdominal radiographs (may detect free air) 1

Risk Factors for Complications

Certain factors increase the risk of complications that may present with fever:

• Procedure-related factors:

  • Therapeutic procedures (polypectomy with cautery) 3
  • Complex polypectomy 5
  • Poor bowel preparation 5

• Patient-related factors:

  • Advanced age (>67 years) 5, 6
  • Recent hospitalization or prior endoscopic procedure 2
  • Use of anticoagulants (particularly warfarin) 3
  • Chronic steroid use 5
  • Comorbidities like Crohn's disease 5

Treatment Considerations

If fever and chills develop after colonoscopy:

1. For suspected perforation:

   • Hospitalization for observation
   • Broad-spectrum antibiotics covering gram-negative bacteria and anaerobes for 3-5 days 1
   • Possible surgical consultation if signs of peritonitis develop 1

2. For suspected infection without perforation:

   • Appropriate antibiotic therapy based on likely source
   • Close monitoring for clinical improvement 1

Prevention of Complications

To minimize the risk of complications:

• Use gentle endoscope progression techniques
• Employ CO2 instead of air for insufflation
• Limit tissue sample size during polypectomy
• Use blended current mode for electrocautery 5

Key Takeaway

Fever and chills after colonoscopy should never be dismissed as normal post-procedure symptoms. They warrant prompt medical evaluation to rule out serious complications like perforation or infection, which could be life-threatening if not addressed quickly. Most endoscopy units provide emergency contact information and instructions to patients before discharge precisely for these situations 1.