Pneumoretroperitoneum with subcutaneous emphysema after a post colonoscopy colonic perforation

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Colonoscopy is a common diagnostic and therapeutic procedure.
• Complications like bleeding and perforation can occur, with extraperitoneal perforations being rare.
• Extraperitoneal perforations may lead to pneumoretroperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema.

Purpose of the Study:

• To report a rare case of combined intraperitoneal and extraperitoneal colonic perforation after diagnostic colonoscopy.
• To highlight the diagnostic challenges and management of such rare presentations.

Main Methods:

• A case report of an 80-year-old female with recurrent abdominal pain undergoing diagnostic colonoscopy.
• CT scan revealed pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema.
• Surgical management with a laparoscopic Hartman procedure was performed.

Main Results:

• The patient presented with severe abdominal pain and tenderness.
• CT findings confirmed extensive gas in the retroperitoneum, peritoneum, and subcutaneous tissues.
• Successful surgical treatment was achieved.

Conclusions:

• Combined intraperitoneal and extraperitoneal colonic perforation is a rare complication of colonoscopy.
• Risk factors include advanced age, female sex, diverticulosis, prior surgery, and colonic strictures.
• Understanding the clinical manifestations is key to timely diagnosis and improved patient outcomes.