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Case Reports
. 2014 Jan-Mar;18(1):136-41.
doi: 10.4293/108680813X13693422521638.

Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy

Ahmed Dehal  1 , Deron J Tessier  2
Affiliations
Case Reports

Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy

Ahmed Dehal et al. JSLS. 2014 Jan-Mar.

Abstract

Both intraperitoneal and extraperitoneal colonic perforations have been reported after colonoscopy; however, cases with combined types of perforation are rare. We present the case of a 55-year-old man with a history of Crohn disease who complained of acute abdominal pain after a diagnostic colonoscopy. Abdominal computed tomography scan showed extensive pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and leftsided pneumothorax. Exploratory laparotomy was performed, and the patient underwent subtotal colectomy and end ileostomy with placement of a left-sided chest drain for the left-sided pneumothorax. The patient was discharged home postoperatively in good condition. As the utility of colonoscopy continues to broaden, its complications will also be more common. Whereas intraperitoneal perforation is a known and not uncommon complication, extraperitoneal perforation is an uncommon complication. Combined intraperitoneal and extraperitoneal perforation is extremely rare, with only a few cases reported in the literature. Early diagnosis and operative management resulted in a satisfactory outcome in this particular case.

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Conflict of interest statement

Conflicts of interest and source of funding: The authors indicate no potential conflict of interest or financial ties.

Figures

Figure 1.
Figure 1.
Colonoscopic view showing (A) patchy nodular mucosa on right side of colon, (B) erythematous mucosa in terminal ileum, and (C) ulcer in terminal ileum.
Figure 2.
Figure 2.
Computed tomography scan of chest and abdomen showing (A) pneumomediastinum and left-sided pneumothorax, (B) retroperitoneal gas, and (C) intraperitoneal and subcutaneous gas.
See this image and copyright information in PMC

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