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Perez Lopez RD, Vargas Flores J, Orbe Garibay LDJ, Narvaez Gonzalez HF. Pneumothorax, Pneumomediastinum, and Cervical and Facial Massive Emphysema Secondary to Colonoscopy: A Rare Complication of Colonoscopy. Case Rep Gastrointest Med 2024; 2024:1140099. [PMID: 38957575 PMCID: PMC11219207 DOI: 10.1155/2024/1140099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Abstract
Background Colonoscopy is a resource used for the diagnosis, treatment, and monitoring of benign and malignant colorectal pathologies. The incidence of perforation is 0.03%-0.65% in diagnostic colonoscopy; however, the incidence can be up to 10 times higher in therapeutic interventions, such as polypectomies, increasing the risk of complications up to 0.07-2.1%. Materials and methods. Case report of a 71-year-old female who presents a rare complication due to a perforation in the sigmoid which developed pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema as a complication of a diagnostic colonoscopy where a biopsy of a friable lesion was performed. Results A 71-year-old female that went to the emergency room due to acute generalized abdominal colic spasm pain with a duration of 7 hours, associated with significant abdominal distension, malaise, diaphoresis, progressive dyspnea, and massive subcutaneous emphysema that developed after performing panendoscopy and colonoscopy for diverticulosis follow-up. An abdominal CT scan with double contrast was performed, reporting suggestive data of hollow viscus perforation, pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema in the thorax, neck, and skull base. She underwent an exploratory laparotomy finding a perforation in the sigmoid for which sigmoidectomy was performed, and for the pneumothorax and pneumomediastinum, endopleural tubes were placed in both hemithoraxes. The massive subcutaneous emphysema subsided with observation and oxygen. Conclusion A rare complication of the use of colonoscopy as a diagnostic and therapeutic method is presented. The purpose of presenting this case is for the doctor who performs these interventions to suspect this complication in a timely manner, not delaying the diagnosis and carrying out an urgent therapeutic approach as in this case with exploratory laparotomy, finding the perforation site and carrying out the corresponding surgical management. We demonstrated that massive subcutaneous emphysema can be managed with observation if there is no other alarm data evident that required another surgical approach.
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Affiliation(s)
| | - Julian Vargas Flores
- Institute for Social Security and Services for State Workers, Mexico City, Mexico
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2
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Montanarella M, Boldig K, Virarkar M, Kumar S, Elsherif S, Lall C, Gopireddy DR. Intraperitoneal anatomy with the aid of pathologic fluid and gas: An imaging pictorial review. J Clin Imaging Sci 2023; 13:13. [PMID: 37292244 PMCID: PMC10246409 DOI: 10.25259/jcis_29_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 06/10/2023] Open
Abstract
The peritoneum is a large serosal membrane enveloping the abdomen and pelvic organs and forming the peritoneal cavity. This complex relationship forms many named abdominopelvic spaces, which are frequently involved in infectious, inflammatory, neoplastic, and traumatic pathologies. The knowledge of this anatomy is essential to the radiologist to localize and describe the extent of the disease accurately. This manuscript provides a comprehensive pictorial review of the peritoneal anatomy to describe pathologic fluid and gas.
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Affiliation(s)
- Matthew Montanarella
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Kimberly Boldig
- Department of Internal Medicine, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Sherif Elsherif
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
| | - Chandana Lall
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, United States
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Pinto AM, Fonte A, Cerqueira R, Sarmento P. Widespread Emphysema After Elective Colonoscopy. ACG Case Rep J 2023; 10:e01026. [PMID: 37073376 PMCID: PMC10106242 DOI: 10.14309/crj.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/13/2023] [Indexed: 04/20/2023] Open
Affiliation(s)
- Ana Marta Pinto
- Department of Anesthesiology, Centro Hospitalar Entre Douro e Vouga, EPE, Portugal
| | - Ana Fonte
- Department of Anesthesiology, Centro Hospitalar Entre Douro e Vouga, EPE, Portugal
| | - Rute Cerqueira
- Department of Gastroenterology, Centro Hospitalar Entre Douro e Vouga, EPE, Portugal
| | - Paula Sarmento
- Department of Anesthesiology, Centro Hospitalar Entre Douro e Vouga, EPE, Portugal
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Basendowah MH, Futayni SA, Ismail RA, Alhazmi HA, Almatrafi AM, Hassan AY, Ashour MA. A Case of Post-Colonoscopy Cecal Perforation in a 78-Year-Old Man Responding to Conservative Management. Cureus 2022; 14:e22364. [PMID: 35371640 PMCID: PMC8938233 DOI: 10.7759/cureus.22364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/05/2022] Open
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Hussain MS, Deliwala SS, Gupta R, Berrou M. Blowing off steam-Identifying bowel perforation after routine colonoscopy. Clin Case Rep 2021; 9:e04515. [PMID: 34322261 PMCID: PMC8299273 DOI: 10.1002/ccr3.4515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/09/2021] [Indexed: 12/02/2022] Open
Abstract
Colonoscopy is an effective procedure for colorectal cancer (CRC) screening. Perforation is a rare yet the most severe complication, identified by landmarks-double dolphin, triangle, or double-wall sign signifying air and intracolonic contents leaking into the peritoneal space. Prompt recognition and surgical intervention are imperative to avoid high mortality.
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Affiliation(s)
- Murtaza S. Hussain
- Department of Internal MedicineMichigan State University at Hurley Medical CenterFlintMIUSA
| | - Smit S. Deliwala
- Department of Internal MedicineMichigan State University at Hurley Medical CenterFlintMIUSA
| | - Rohit Gupta
- Department of Internal Medicine/PediatricsMichigan State University at Hurley Medical CenterFlintMIUSA
| | - Mohammed Berrou
- Division of Pulmonary/Critical CareDepartment of Internal MedicineMichigan State University at Hurley Medical CenterFlintMIUSA
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6
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Shacket RA, Gillis BJ, Guthrie CS. Mesenteric Tear Can Be Caused by Abdominal Counter-Pressure Applied During Colonoscopy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928889. [PMID: 33863867 PMCID: PMC8057283 DOI: 10.12659/ajcr.928889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 72-year-old Final Diagnosis: Mesenteric hematoma Symptoms: Abdominal pain • bloating • nausea • vomiting Medication: — Clinical Procedure: Screening colonoscopy • followed by open laparoscopy with the evacuation of a hematoma Specialty: Gastroenterology and Hepatology • Surgery
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Affiliation(s)
- Rick A Shacket
- Department of Surgery, Abrazo Central Campus Hospital, Phoenix, AZ, USA
| | - Brian J Gillis
- Department of Surgery, Northern Light Inland Hospital, Waterville, ME, USA
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Hsiao YT, Lin SW, Chuang PW, Tsai MJ. Pneumomediastinum, Pneumoretroperitoneum, Pneumoperitoneum and Subcutaneous Emphysema Secondary to a Penetrating Anal Injury. Diagnostics (Basel) 2021; 11:diagnostics11040707. [PMID: 33920850 PMCID: PMC8071121 DOI: 10.3390/diagnostics11040707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/03/2022] Open
Abstract
Simultaneous occurrence of pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema is rare. The most reported mechanisms are barotrauma, thermal injury and instrument puncture caused by colonoscopy. Ectopic air may travel into different body compartments through distinct anatomical fascial planes. Definite curative treatment involves surgical repair of the bowel wall defect. Conservative treatment is available in selected patients. Here, we present a case of traumatic penetrating rectal injury leading to developing air in the peritoneum, retroperitoneum, mediastinum, and subcutaneous space with good recovery under conservative treatment.
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Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey. BJGP Open 2020; 4:bjgpopen20X101007. [PMID: 32019773 PMCID: PMC7330201 DOI: 10.3399/bjgpopen20x101007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There has been interest in using the non-invasive, home-based quantitative faecal immunochemical test (FIT) to rule out colorectal cancer (CRC) in high-risk symptomatic patients. AIM To elicit public preferences for FIT versus colonoscopy (CC) and its delivery in primary care. DESIGN & SETTING A cross-sectional online survey in England. METHOD A total of 1057 adults (without CRC symptoms and diagnosis) aged 40-59 years were invited from an English online survey panel. Responders were asked to imagine they had been experiencing CRC symptoms that would qualify them for a diagnostic test. Participants were presented with choices between CC and FIT in ascending order of number of CRCs missed by FIT (from 1-10%). It was measured at what number of missed CRCs responders preferred CC over FIT. RESULTS While 150 participants did not want either of the tests when both missed 1% CRCs, the majority (n = 741, 70.0%) preferred FIT to CC at that level of accuracy. However, this preference reduced to 427 (40.4%) when FIT missed one additional cancer. Women were more likely to tolerate missing CRC when using FIT. Having lower numeracy and perceiving a higher level of risk meant participants were less likely to tolerate a false negative test. Most of those who chose FIT preferred to return it by mail (62.2%), to be informed about normal test results by letter (42.1%), and about abnormal test results face to face (32.5%). CONCLUSION While the majority of participants preferred FIT over CC when both tests had the same sensitivity, tolerance for missed CRCs was low.
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Weng E, Valencia DN, Krudy ZA, Ali M. Intraperitoneal and Extraperitoneal Colonic Perforation Following Diagnostic and Therapeutic Colonoscopy with Crohn's-related Stricture Dilation. Cureus 2020; 12:e7162. [PMID: 32257705 PMCID: PMC7112721 DOI: 10.7759/cureus.7162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Colonic perforation is an uncommon but known and feared complication of colonoscopy, which carries a high mortality rate. We present an uncommon case of extensive intra- and extraperitoneal air following colonic perforation in a patient undergoing inpatient colonoscopy for evaluation of unintentional weight loss and constipation. During colonoscopy, a splenic flexure stricture was identified and dilated. Postprocedural hemodynamic instability prompted further imaging which revealed pneumoperitoneum, bilateral pneumothorax, pneumomediastinum, pneumopericardium, and severe subcutaneous emphysema. Emergent exploratory laparotomy found perforation of the proximal transverse colon which required resection and transverse colostomy placement. The patient also underwent bilateral chest tube placement and was treated with antibiotics for peritonitis. The patient was eventually diagnosed with Crohn’s disease and discharged to an extended care facility with outpatient follow-up. Extraperitoneal colonic perforations are fairly rare, and to our knowledge, we present the most severe case that has been published in recent years.
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Affiliation(s)
- Emily Weng
- Internal Medicine, Kettering Medical Center, Kettering, USA
| | | | - Zoltan A Krudy
- Internal Medicine, Kettering Medical Center, Kettering, USA
| | - Median Ali
- Pulmonary Medicine and Critical Care, Kettering Medical Center, Kettering, USA
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10
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Bots EMT, Hoek RAS. Pneumomediastinum Due to Traumatic Rectal Perforation. Am J Respir Crit Care Med 2020; 201:e15-e16. [DOI: 10.1164/rccm.201902-0276im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Eva M. T. Bots
- Department of Pulmonary Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rogier A. S. Hoek
- Department of Pulmonary Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Kothari ST, Huang RJ, Shaukat A, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Gurudu SR, Khashab MA, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Thosani N, Yang J, DeWitt JM, Wani S. ASGE review of adverse events in colonoscopy. Gastrointest Endosc 2019; 90:863-876.e33. [PMID: 31563271 DOI: 10.1016/j.gie.2019.07.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included.
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Affiliation(s)
| | - Robert J Huang
- Stanford University Medical Center, Stanford, California, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deepak Agrawal
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Douglas S Fishman
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | | | | | - Laith H Jamil
- Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Terry L Jue
- The Permanente Medical Group, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Joanna K Law
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Mariam Naveed
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals & Clinics, Coralville, Iowa, USA
| | | | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav Thosani
- University of Texas at Houston, Bellaire, Texas, USA
| | - Julie Yang
- Einstein Hospital, New York, New York, USA
| | - John M DeWitt
- Division of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
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12
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Jaafar S, Hung Fong SS, Waheed A, Misra S, Chavda K. Pneumoretroperitoneum with subcutaneous emphysema after a post colonoscopy colonic perforation. Int J Surg Case Rep 2019; 58:117-120. [PMID: 31035226 PMCID: PMC6487361 DOI: 10.1016/j.ijscr.2019.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/11/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023] Open
Abstract
Colonic perforation after colonoscopy could be intraperitoneal, extraperitoneal or a combination of both. Majority of the perforations are intraperitoneal. Risk factors include advance age, female sex, diverticulosis, previous abdominal surgery and colonic strictures. Extraperitoneal perforations can manifest as pneumoretroperitoneum, pneumomediastinum, pneumothorax and/or subcutaneous emphysema. Non operative management in isolated retroperitoneum while surgery required in majority of peritoneal perforation.
Introduction Colonoscopy is considered as one of the most common performed procedures for both diagnostic and therapeutic purposes. Serious complication after colonoscopy could occurs like bleeding or perforation. Majority of the perforations are intraperitoneal, while extraperitoneal perforations are very rare and it may cause pneumoretroperitoneum, pneumomediastinum, pneumothorax and subcutaneous emphysema. Presentation of the case A case report was described of 80-year-old female who underwent a diagnostic colonoscopy for recurrent abdominal pain who presented with severe abdominal pain and tenderness with CT findings of pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema. The patient successfully treated surgically with laparoscopic Hartman procedure. Discussion Colonic perforation is rare complication of colonoscopy that can manifest intraperitoneal, extraperitoneal or a combination of both. Patient risk factors include advance age, female sex, diverticulosis, previous abdominal surgery and pre-existing colonic strictures. Technical risk factors includes excessive shearing forces during endoscopic insertion, dilation, biopsy and using electrocautery. Majority of the intraperitoneal perforation warrant a surgical intervention whereas isolated extraperitoneal perforation may be managed conservatively. Conclusion Combined intraperitoneal and extraperitoneal colonic perforation are rare presentations following diagnostic colonoscopy and often difficult to diagnose based on the clinical manifestation only. Understanding the manifestation of extraperitoneal perforation will help to properly identify the condition and preventing morbidity and mortality in these patients.
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Affiliation(s)
| | | | - Abdul Waheed
- Brandon Regional Hospital, Brandon, FL, 33511, USA
| | | | - Keyur Chavda
- Brandon Regional Hospital, Brandon, FL, 33511, USA
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The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction. Case Rep Surg 2018; 2018:8020197. [PMID: 30123608 PMCID: PMC6079430 DOI: 10.1155/2018/8020197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/18/2018] [Accepted: 06/29/2018] [Indexed: 01/14/2023] Open
Abstract
Colonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and symptoms may develop. The aim of this report is to raise the awareness on the likelihood of rare clinical features of colonoscopic perforation. A 72-year-old male patient with a past medical history of myocardial infarction presented to the emergency department four hours after a screening colonoscopy with polypectomy, complaining of neck pain, retrosternal oppressive chest pain, dyspnea, and rhinolalia. Right chest wall and cervical subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and bilateral subdiaphragmatic free air were reported on the chest and abdominal X-rays. The patient was treated conservatively, with absolute bowel rest, total parental nutrition, and broad-spectrum intravenous antibiotics. Awareness of the potentially unusual clinical manifestations of retroperitoneal perforation following colonoscopy is crucial for the correct diagnosis and prompt management of colonoscopic perforation. Conservative treatment may be appropriate in patients with a properly prepared bowel, hemodynamic stability, and no evidence of peritonitis. Surgical treatment should be considered when abdominal or chest pain worsens, and when a systemic inflammatory response arises during the conservative treatment period.
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14
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Lee HS, Park HH, Kim JS, Kang SH, Moon HS, Sung JK, Lee BS, Jeong HY. Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema after Diagnostic Colonoscopy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:145-149. [DOI: 10.4166/kjg.2017.70.3.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Hee Sung Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hwan Hee Park
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ju Seok Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Yong Jeong
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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