Bilateral Tension Pneumothoraces During Colonoscopy: A Case Report and Review of Literature

An 83-year-old man with metastatic esophageal and colon cancer underwent a therapeutic colonoscopy in an attempt to place a colonic stent to alleviate symptoms of severe bowel obstruction. Moderate sedation with intravenous propofol was provided during the case. During the procedure, the patient experienced bilateral tension pneumothoraces and subcutaneous emphysema of the neck and face. A needle decompression of the tension pneumothorax was performed emergently, and chest tubes were subsequently inserted bilaterally in the intensive care unit. Colonic perforation was highly suspected based on the clinical manifestations and procedural difficulties, although a diagnostic abdominal computed tomography scan was never completed because of the family's desire to provide only comfort care. The patient died 24 hours after the event. A literature search revealed that 10 cases of pneumothorax occurred following a colonoscopy. The purpose of this case report and review of the literature is to increase awareness of pneumothorax as an extremely rare but severe and often life-threatening complication of colonoscopy among anesthesia care providers. The mechanisms of pneumothorax development are also discussed.