“Ulcerative crepitus” — A case with subcutaneous emphysema and pneumomediastinum without colonic perforation or toxic megacolon in ulcerative colitis successfully treated conservatively

Colon perforation is an uncommon but serious complication of colonoscopy. It may occur as either intraperitoneal or extraperitoneal perforation or in combination. The majority of colonic perforations are intraperitoneal, causing air and intracolonic contents to leak into the peritoneal space. Rarely, colonic perforation can be extraperitoneal, leading to the passage of air into the retroperitoneal space causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. A literature review revealed that 31 cases of extraperitoneal perforation exist, out of which 20 cases also reported concomitant intraperitoneal perforation. We report the case of a young female with a history of ulcerative colitis who developed combined intraperitoneal and extraperitoneal perforation after colonoscopy. We also report the duration of onset of symptoms, clinical features, imaging findings, site of leak, and treatment administered in previously reported cases of extraperitoneal colonic perforation.

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Splenic Rupture Secondary to Venous Thrombosis in a Patient with Ulcerative Colitis and Toxic Megacolon

The American Surgeon ◽

10.1177/000313481007600508 ◽

2010 ◽

Vol 76 (5) ◽

pp. 31-32 ◽

Cited By ~ 1

Author(s):

Sean J. Langenfeld ◽

Noel C. Sanchez

Keyword(s):

Ulcerative Colitis ◽

Venous Thrombosis ◽

Splenic Rupture ◽

Toxic Megacolon

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Management of Severe Attacks of Ulcerative Colitis with New Technologies

Canadian Journal of Gastroenterology ◽

10.1155/1990/353874 ◽

1990 ◽

Vol 4 (7) ◽

pp. 347-349

Author(s):

M Campieri ◽

P Gionchetti ◽

A Belluzzi ◽

M Tampieri ◽

C Brignola ◽

...

Keyword(s):

Ulcerative Colitis ◽

Transverse Colon ◽

Bowel Wall ◽

New Technologies ◽

Toxic Megacolon ◽

Abdominal Ultrasound ◽

Histological Evaluation ◽

Excellent Correlation ◽

Severe Ulcerative Colitis ◽

Descending Colon

Barium enema and colonoscopy are contraindicated in severe attacks of ulcerative colitis because of the possibility of toxic megacolon and perforation. The authors have assessed abdominal ultrasound in 38 patients with severe ulcerative colitis. Ultrasound revealed bowel wall thicknesses ranging from 3.9 to 9.2 mm (mean 7.7) extending the whole length of the colon, to the transverse colon, and to the descending colon, respectively, in 18, 10 and eight patients. The degree of bowel thickening was related to the severity of inflammation based on clinical, sigmoidoscopic and histological evaluation. In two patients, ultrasound showed a thin bowel wall distended without motility, suggesting the diagnosis of toxic megacolon (confirmed radiologically). An excellent correlation (95%) was found between ultrasound and technetium-99 scanning. Ultrasound might be a reasonable first investigation in the assessment of patients with severe ulcerative colitis.

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