Tension Pneumothorax Secondary to Colonic Perforation During Diagnostic Colonoscopy: Report of a Case

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence of colonic perforation. This patient developed a simultaneous pneumoperitoneum, pneumomediastinum, and a tension pneumothorax requiring immediate tube thoracostomy. This case may raise the awareness on the likelihood of these serious complications after colonoscopy.

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Su1486 The Comparison of Endoscopic Closure With Surgical Operation in Iatrogenic Colonic Perforation During Diagnostic Colonoscopy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2012.03.911 ◽

2012 ◽

Vol 75 (4) ◽

pp. AB349

Author(s):

Kwang an Kwon ◽

Jong Joon Lee ◽

Jung Ho Kim ◽

Yoon Jae Kim ◽

Chung Jun Won ◽

...

Keyword(s):

Colonic Perforation ◽

Surgical Operation ◽

Diagnostic Colonoscopy ◽

Endoscopic Closure

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Successful Endoscopic Repair of an Iatrogenic Colonic Perforation During Diagnostic Colonoscopy

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2012.03.110070 ◽

2012 ◽

Vol 25 (3) ◽

pp. 383-389 ◽

Cited By ~ 2

Author(s):

S. H. Lee ◽

Y. S. Cheong

Keyword(s):

Colonic Perforation ◽

Endoscopic Repair ◽

Diagnostic Colonoscopy

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Large-sized iatrogenic colonic perforation during diagnostic colonoscopy

Gastrointestinal Intervention ◽

10.18528/gii180023 ◽

2018 ◽

Vol 7 (2) ◽

pp. 94-97

Author(s):

Seung Yong Shin ◽

Eun Jung Park ◽

Jae Jun Park

Keyword(s):

Colonic Perforation ◽

Diagnostic Colonoscopy

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Anatomical and Radiological Considerations When Colonic Perforation Leads to Subcutaneous Emphysema, Pneumothoraces, Pneumomediastinum, and Mediastinal Shift

The Surgery Journal ◽

10.1055/s-0038-1624563 ◽

2018 ◽

Vol 04 (01) ◽

pp. e7-e13 ◽

Cited By ~ 1

Author(s):

Sala Abdalla ◽

Rupinder Gill ◽

Gibran Yusuf ◽

Rosaria Scarpinata

Keyword(s):

Subcutaneous Emphysema ◽

Rare Case ◽

Interventional Procedures ◽

Colonic Perforation ◽

Lower Limbs ◽

Safe Procedure ◽

Diagnostic Colonoscopy ◽

Mediastinal Shift ◽

Radiological Images ◽

Body Compartments

AbstractWhile colonoscopy is generally regarded as a safe procedure, colonic perforation can occur and the risk of this is higher when interventional procedures are undertaken. The presentation may be acute or delayed depending on the extent of the perforation. Extracolonic gas following colonic perforation can migrate to several body compartments that are embryologically related and it has previously been reported in the thorax, mediastinum, neck, scrotum, and lower limbs. This review discusses in detail the anatomical pathways that led to a rare case of widespread subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and mediastinal shift from colonic perforation during a diagnostic colonoscopy. This is further supported by a description of the radiological images.

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Intraperitoneal and Extraperitoneal Colonic Perforation Following Diagnostic Colonoscopy

JSLS Journal of the Society of Laparoendoscopic Surgeons ◽

10.4293/108680813x13693422521638 ◽

2014 ◽

Vol 18 (1) ◽

pp. 136-141 ◽

Cited By ~ 12

Author(s):

Ahmed Dehal ◽

Deron J. Tessier

Keyword(s):

Colonic Perforation ◽

Diagnostic Colonoscopy

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EP.FRI.978 Colonoscopy perforation: A single centre experience

British Journal of Surgery ◽

10.1093/bjs/znab312.139 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

M A Gok ◽

K Habeeb ◽

C J Smart ◽

S J Ward ◽

U A Khan

Keyword(s):

Colorectal Cancer ◽

Adverse Event ◽

Colonic Perforation ◽

Concomitant Disease ◽

Single Centre ◽

Diagnostic Colonoscopy ◽

Cancer Symptoms ◽

Single Centre Experience ◽

Diversion Stoma ◽

Diseased Bowel

Abstract Aims Colonic perforation is an adverse event of colonoscopy. This is around 1/1500 in diagnostic colonoscopy, 1/500 in polypectomy procedures & 1/50 in EMR procedure. This study is to evaluate the management of colonic perforation at a single centre. Methods Colonoscopy carried out on patients with colorectal cancer symptoms, family history, colorectal cancer & polyp surveillance. Retrospective study carried out since 2012 on all colonoscopies with evaluation of colonoscopy perforation. Conclusion 7 colonoscopy perforations encountered over 8 years, with incidence of 0.03 - 0.06 % per year. Surgery undertaken in 5 cases with concomitant disease bowel (2 IBD’s & 3 diverticulitis). 2 cases of conservative management. Surgical resection of diseased bowel occurred in 4 cases with 4 cases of diversion stoma. One case of diversion stoma was subsequently reversed, whilst other 2 case were deemed medically unfit. Colonoscopy is carried out by JAG accredited endoscopists. Colonic perforation during colonoscopy is increased in: polypectomy (right colonic), therapeutic EMR, diseased bowel (IBD, diverticular disease), challenging colons. Management of colonoscopy perforation should individualized with early clinical & radiological diagnosis.

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