![]() The aim of this report is to alert to a possible underestimated, late consequence of colorectal carbon-based marker tattooing, namely pronounced fibrosis at the site of the injection that could lead to a blurring and misinterpretation of changes evaluated by radiological techniques. Although carbon is thought to be nontoxic, there usually is some inflammatory reaction with fibrosis and granuloma formation after tissue injection. India ink, at appropriated concentrations, appears to be a safe short- and long-term colonic tattooing agent.Endoscopic colorectal tattooing with carbon-based dyes is commonly employed in order to assist with later localization of the lesion. Dilute concentrations that caused little to no inflammation could be visualized at 7 days and 1 month in rabbits and dogs and at 5 months in rabbits. India ink was an effective colonic tattooing agent. Indocyanine green was an ineffective colonic tattooing agent. The tattoos produced with the 1:100 and 1:1000 concentrations at 0.5 mL and 1.0 mL injection volumes were easily seen by all methods of intraabdominal visualization at 1 month with similar histology. The tattoo with the 1:100 concentration at 0.5 mL was seen consistently at colonoscopy, laparoscopy, and laparotomy with only a mild submucosal reaction at 7 days. India ink was also studied at 7 days and 1 month in dogs. Tattoos produced with all other India ink concentrations were visible without gross inflammation. ![]() The undiluted and 1:10 concentrations were easily seen and showed evidence of mucosal ulceration. India ink studied at 7 days, 1 month, and 5 months after injection in the rabbit model was visible at all concentrations. Injections of both concentrated and diluted indocyanine green caused mucosal ulceration and moderate to severe inflammation. The concentrated indocyanine green solution was easily visible only on day 1 in the rabbit. Histology in the rabbit was judged by degrees of inflammation (0 = no inflammation, 2 = mild inflammation, 4 = moderate inflammation, 6 = severe inflammation). Tattoo visibility at re-exploration in both animal models was graded on a scale (0 = agent not seen, 1 = seen with difficulty, 2 = easily seen). Re-exploration by colonoscopy, laparoscopy, and laparotomy was done at 7 days and 1 month. Twelve mongrel dogs (20 kg) were injected with 1.0 mL volumes. Additionally, 16 rabbits were injected with India ink at laparotomy and re-explored at 1 and 5 months. Laparotomy was repeated at days 1, 3, and 7 after injection. ![]() Tuberculin syringes were used to create a 0.1 mL serosal bleb at two injection sites 2 cm apart. Twenty-two New Zealand white rabbits (2 kg) were anesthetized and injected with India ink (undiluted 1:10, 1:50, 1:100, 1:1000, 1:10,000) and indocyanine green as an undiluted, concentrated formulation (25 mL/2 mL solvent) or in a diluted form (25 mg/5 mL solvent) at various concentrations (1:10, 1:50, 1:100). The purpose of this study was to determine (1) the concentrations of India ink and indocyanine green that resulted in high-visibility tattoos without significant tissue inflammation and (2) the India ink injection volume that produces best visibility at colonoscopy, laparoscopy, and laparotomy. Controversy exists concerning the safety and efficacy of colonic tattooing for the intraoperative identification of polypectomy sites.
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