Korean J Gastrointest Endosc.  2011 Jan;42(1):38-42.

Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation

Affiliations
  • 1Department of Internal Medicine, Wallace Memorial Baptist Hospital, Busan, Korea. lovetoje@hanmail.net

Abstract

A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping.

Keyword

Colonoscopy; Perforation; Pneumothorax; Pneumomediastinum; Subcutaneous emphysema
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