S. Jaafar1, S. Hung Fong1, S. Misra1,2, K. Chavda1 1Brandon Regional Hospital,GME – Surgery,Brandon, FL, USA 2HCA,West Florida,Tampa, FL, USA
Introduction: Colonoscopy is considered one of the most commonly performed procedure for both diagnostic and therapeutic purposes. However, serious complications such as bleeding, and much rarely, colonic perforation can still occur at a rate of 0.03-0.8% Colonic perforation can be classified as intraperitoneal, extraperitoneal or a combination of both. Majority of the perforations are intraperitoneal, while extraperioneal perforations can manifest as pneumoretroperitoneum, pneumomediastinum, pneumothorax and/or subcutaneous emphysema. We report a rare case of post colonoscopy colonic perforation presenting with peritonitis, pneumoretroperitoneum and subcutaneous emphysema.
Methods: A case report was described of a 80-year-old female who underwent a routine colonoscopy and presented with colonic perforation associated with pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema and surgically treated with Hartmann procedure. Related articles were searched through Pudmed, Google Scholar and Cochrane and a review of literatures regarding risk factors; most common site of perforation and the mechanism of perforation; the difference of manifestations and management approach between intraperitoneum and extraperitoneum.
Results: Some of the risk factors include advance age, female sex, diverticulosis, previous abdominal surgery and colonic strictures. The most common site of perforation is the sigmoid colon followed by the cecum due to shearing forces applied during endoscopic insertion during dilation, biopsy and/or resection. Majority of the perforation are intraperitoneal, but extraperitoneal can manifest in the mediastinum, pleura, scrotum and subcutaneous tissue. 60% of the combined intraperitoneal and extraperitopeal perforations were treated surgically, while 75% of the isolated extraperitoneal perforation were treated conservatively.
Conclusion: Colonoscopy is considered the gold standard for screening colorectal cancer and is useful in the workup of many gastrointestinal conditions, but complication associated with colonic perforation is rare that can manifest intraperitoneal, extraperitoneal or a combination of both. Majority of the intraperitoneal perforation warrant a surgical intervention whereas isolated extraperitoneal perforation can mostly be managed conservatively. Understanding the manifestation of extraperitoneal perforation will help us properly identify the associated morbidities and preventing mortality in these patients.
