"Cat Scratch Colon" and Cecal Barotrauma perforation during colonoscopy using CO2 insufflation

Area of Science:

• Gastroenterology
• Endoscopic procedures
• Patient safety

Background:

• Cecal perforation from barotrauma is a known complication of colonoscopy using room air.
• Carbon dioxide (CO2) is preferred for insufflation due to faster absorption and reduced patient discomfort.
• CO2 is generally considered protective against barotrauma injuries during endoscopy.

Observation:

• A case of cecal perforation occurred during a routine screening colonoscopy.
• Carbon dioxide (CO2) was used for insufflation in this procedure.
• The perforation was attributed to barotrauma, a mechanism not previously reported with CO2 insufflation.

Findings:

• Colonoscopy with CO2 insufflation can lead to cecal perforation via barotrauma.
• This represents a rare but serious complication, challenging the assumption of CO2's complete safety against barotrauma.
• The mechanism of injury highlights potential risks associated with excessive insufflation pressures.

Implications:

• Endoscopists must remain vigilant for barotrauma even when using CO2 for insufflation.
• Further research may be needed to define safe CO2 insufflation limits during colonoscopy.
• Patient safety protocols may require updates to address this rare complication.