Large-sized iatrogenic colonic perforation during diagnostic colonoscopy

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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Tension Pneumothorax, Pneumoperitoneum, and Cervical Emphysema following a Diagnostic Colonoscopy

Case Reports in Emergency Medicine ◽

10.1155/2013/583287 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Ali Pourmand ◽

Hamid Shokoohi

Keyword(s):

Rare Case ◽

Tension Pneumothorax ◽

Colonic Perforation ◽

Tube Thoracostomy ◽

Diagnostic Colonoscopy ◽

Rare Case Report ◽

Initial Injury ◽

Life Threatening ◽

Life Threatening Complication ◽

Anatomical Connection

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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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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One reason for colonic perforation in diagnostic colonoscopy: looping of the colonoscope

Research ◽

10.13070/rs.en.2.1447 ◽

2015 ◽

Vol 2 ◽

Author(s):

Yusuf Yucel ◽

Ahmet Seker ◽

Timucin Aydogan ◽

Abdullah Ozgonul ◽

Alpaslan Terzi ◽

...

Keyword(s):

Colonic Perforation ◽

Diagnostic Colonoscopy

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Post colonoscopy colonic perforation with parietal abscess: a rare case report

International Surgery Journal ◽

10.18203/2349-2902.isj20214021 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3185

Author(s):

Manoj K. Choudhury ◽

Utpal Baruah ◽

S. K. M. Azharuddin

Keyword(s):

Colonic Perforation ◽

Retroperitoneal Abscess ◽

Sensitivity Testing ◽

Diagnostic Colonoscopy ◽

Conservative Care ◽

Rare Case Report ◽

Intravenous Hydration ◽

Colon And Rectum ◽

The Subject ◽

Contrast Ct

Colonoscopy is a common method of diagnosing colon and rectum illnesses. Complications from colonoscopy are rare. However, perforation is one of the most common problems observed. The incidence is 0.005-0.085 percent. Extraperitoneal and mixed postcolonoscopy colonic perforations are classified as intraperitoneal, extraperitoneal and both combined. Extraperitoneal perforation is rare and frequently accompanied with subcutaneous emphysema and retroperitoneal abscess. Contrast CT scan is the most effective diagnostic and therapy tool. A parietal abscess after colonoscopy is quite rare. Only one incidence of post-colonoscopy retroperitoneal colonic perforation with parietal abscess has been reported. An unusual case of colonic perforation after diagnostic colonoscopy was presented with a parietal abscess on the left iliac area. The patient, a 63-year-old diabetic male, had a diagnostic colonoscopy for intestinal irregularity. Afternoon severe ache over left iliac region brought patient to doctor. Nothing notable was discovered. So, they prescribed symptomatic drugs. Symptomatic medications were prescribed but without any relief. An abdominal contrast CT was recommended to him by his doctor after a few days. This retro muscular accumulation in the left transverses abdominis muscle communicated with the sigmoid colon. No signs of peritonitis or septicemia. Patient was stable. The aspirated fluid was sent for culture and sensitivity testing, and intravenous hydration and antibiotics were commenced. Patient tolerated conservative care. The subject was discharged in 2 weeks. Diagnosis and treatment of perforation are critical to recovery.

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Endoscopic Management of an Iatrogenic Colonic Perforation Using Standard Hemoclips

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_23_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 201-204

Author(s):

Sanjeev Kumar ◽

Saket Kumar ◽

Sujit Kumar ◽

Vijay Prakash

Keyword(s):

Present Report ◽

Nonoperative Treatment ◽

Colonic Perforation ◽

Endoscopic Management ◽

Diagnostic Colonoscopy ◽

Sigmoid Perforation ◽

Intravenous Antibiotics ◽

Recent Advancement ◽

Effective Option ◽

Life Threatening

AbstractIatrogenic colonic perforation is an unusual but life‑threatening complication of colonoscopy. The recent advancement in endoscopy technology has made nonoperative treatment a safe and effective option for managing such perforations. A 70‑year‑old man sustained an iatrogenic sigmoid perforation during diagnostic colonoscopy. The abdominal X‑ray showed free gas under diaphragm. He was started on conservative management and intravenous antibiotics. He underwent a second colonoscopy after 2.5‑h, perforation was identified and closed with standard hemoclips. He recovered well and was discharged from hospital 6 days later. There are only a handful of reports in the medical literature describing successful outcomes following endoscopic management. Most of the cases have been managed with over‑the‑scope clips or endoscopic sutures that are quite expensive. In the present report, an iatrogenic sigmoid perforation was managed endoscopically with standard hemoclips. The hemoclip can be an effective, yet economical method of perforation repair in selected cases.

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