Pitfalls of single-site tattooing of suspicious or significant polyps at colonoscopy in patients undergoing colectomy

Abstract

This is a case report of a single-site tattooing opposite the index lesion at colonoscopy. At laparoscopic surgery, the tattoo was not visible intraabdominally and on-table flexible sigmoidoscopy revealed that the tattoo was proximal to the scar tissue. Had tattoo been visible, this could have led to adverse effects with the resection point being proximal to or through the lesion. As endoscopic mucosal resection is done in patients lying flat, while surgical procedures are performed in a 30° Trendelenberg, this could have led to relative differences in the position of the tattoo and index lesion. It should become standard practice that all lesions that need tattooing should be done circumferentially distal to the index lesion. When only single-site tattooing is done, if the patient needs surgery, then a preoperative distal tattooing should be done.