Pneumatic ileal perforation: an unusual complication of colonoscopy

Pneumatic perforation of the bowel is a rare complication of colonoscopy. Pneumatic ileal perforation complicating this procedure has not been reported. We describe a case of pneumatic ileal perforation during colonoscopy in an elderly lady who also had adhesions from previous abdominal surgery. A relative lack of symptomatology, the finding of a clean ileal perforation at surgery, and a benign postoperative period characterized her course. Possible etiological factors are discussed with reference to the literature dealing with intraluminal pressures in the bowel. Pressure much higher than the physiological pressure is likely to be reached during colonoscopy, with reflux of air across the ileocecal sphincter acting as a safety mechanism. Bursting pressures differ for different layers of the bowel and from segment to segment. This report calls attention to certain risk factors which might lead to a remote perforation during colonoscopy.