Explosive Vomiting Associated with Proximal Colonic Distention during a Difficult Propofol-Assisted Colonoscopy

Area of Science:

• Gastroenterology
• Anesthesiology
• Clinical Medicine

Background:

• Colonoscopy is a common procedure for diagnosing and treating colorectal conditions.
• Propofol sedation is frequently used, enabling deep sedation and extensive scope manipulation.
• Vomiting during colonoscopy, particularly with deep sedation, poses risks like aspiration pneumonitis.

Observation:

• A case of explosive vomiting occurred during a difficult colonoscopy with extensive proximal colon manipulation.
• Vomiting onset correlated directly with proximal colonic distention, without prodromal symptoms.
• The patient was under deep sedation with propofol, which can attenuate airway reflexes.

Findings:

• Proximal colonic distention is identified as the most probable cause of vomiting in this case.
• The neurocircuitry of vomiting suggests a plausible link between colonic distention and emetic responses.
• Deep sedation with propofol may increase the risk of vomiting due to enhanced colonic manipulation possibilities.

Implications:

• Increased vigilance during proximal colon manipulation in colonoscopy is recommended.
• Healthcare providers should be aware of the potential for vomiting and aspiration in sedated patients.
• Understanding the mechanism of vomiting related to colonic distention can inform procedural safety protocols.