Colonic Abscess Induced by India Ink Tattooing

Chang Seok Bang; Yeon Soo Kim; Gwang Ho Baik; Sang Hak Han

doi:10.4166/kjg.2014.64.1.45

Journal List > Korean J Gastroenterol > v.64(1) > 1007321

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Bang, Kim, Baik, and Han: Colonic Abscess Induced by India Ink Tattooing

Case Report

Korean J Gastroenterol 2014;64(1):45-48.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.1.45

Colonic Abscess Induced by India Ink Tattooing

Chang Seok Bang, Yeon Soo Kim, Gwang Ho Baik, Sang Hak Han¹

Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea

¹Department of Pathology, Hallym University College of Medicine, Chuncheon, Korea

Correspondence to: Yeon Soo Kim, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon 200-704, Korea. Tel: +82-33-240-5821, Fax: +82-33-241-8064, E-mail: kimyeonsoo@hallym.or.kr

Received 1 October 201320 November 2013 Accepted 2 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Endoscopic tattooing with India ink is generally regarded as a safe procedure that enables ready identification of endoluminal cancer from the serosal surface. However, significant complications have been reported, including local inflammatory pseudotumor formation, peritonitis, rectus muscle abscess, small bowel infarction, and phlegmonous gastritis. Although the mechanism of complication is not completely understood, it may be related to the chemical compounds contained in the ink solution and enteric or extraenteric bacterial inoculation by injection needle or the ink itself. Authors encountered a case of a 60-year-old man with a resectable sigmoid colon cancer which was tattooed with India ink for subsequent localization in the intraoperative setting. During the laparoscopic operation, the proximal and distal margin of the lesion appeared edematous with bluish color. The distal resection margin was extended approximately 5 cm more than expected because of long extent of edematous mucosa. Histologic examination of the edematous tattooing area revealed an ink abscess spreading laterally above the muscularis propria. Although tattooing is widely used and relatively safe, the presented case indicates the risk of infection or inflammation by tattooing.

Keywords: Tattooing, Adverse effects, Abscess, Chinese ink

References

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Fig. 1.

Colonoscopic India ink tattooing. (A) A 2-cm sized ulcerofungating mass in the mid sigmoid colon. (B) A 1.0-mL submucosal injection was made at the proximal and distal border of the lesion (total of 2.0 mL).

Fig. 2.

Gross findings. Resected specimen shows two injection sites with edematous mucosa.

Fig. 3.

Histologic findings. Large collection of polymorphonuclear cells, macrophages, and black pigments in the submucosa. Neutrophils infiltrated into the subserosa, invading muscularis propria (H&E, ×100).

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