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Case report: Tension pneumoperitoneum after diagnostic colonoscopy in an 11 y/o boy with Crohns disease
Sigurd T Seitz1, Aline Rückel2, Gregor Siebenlist2
1Department of Pediatric Surgery, University Medical Center Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Insights
A rare case of tension pneumoperitoneum after pediatric endoscopy highlights the risks in inflammatory bowel disease patients. Even without a visible perforation, this serious complication requires careful post-procedure monitoring.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Surgical Complications
Background:
- Endoscopy is a safe and common diagnostic and therapeutic tool in pediatric gastroenterology.
- Complications are rare but can occur, necessitating awareness and careful patient management.
Observation:
- An 11-year-old boy with a history of inflammatory bowel disease developed abdominal distension and pain post-panendoscopy.
- Radiological evidence confirmed tension pneumoperitoneum, a rare but serious complication.
Findings:
- Surgical exploration revealed gaseous insufflation of mesenteric tissue, likely due to microperforations, rather than a free gastrointestinal perforation.
- The patient recovered with conservative management, including antibiotics and abdominal lavage.
Implications:
- This case underscores the potential for tension pneumoperitoneum even without macroscopic perforation after pediatric endoscopy.
- Physicians must remain vigilant for rare complications, especially in pediatric patients with chronically altered intestines due to inflammatory bowel disease.
Introduction:
Endoscopy is an established diagnostic and therapeutic tool in paediatric gastroenterology and a save method with rare complications.
Presentation Of Case:
We present the case of an 11-year-old Caucasian boy with a long history of inflammatory bowel disease. Three years prior an ileostomy was created and is still in position. After diagnostic panendoscopy (colonoscopy, gastroscopy, endoscopy of small intestine via ileostomy) the patient showed progressive abdominal distension and pain. After diagnosis of tension pneumoperitoneum by radiological proof of massive intraabdominal air and altered vital signs, we initiated emergency laparotomy. Surgical intervention ruled out a free gastrointestinal perforation as well as peritonitis. There was a gaseous insufflation of the mesenteric tissue of the sigmoid and upper rectum most likely according to microperforations to the mesentery. Due to the pre-existing ileostomy, we took no further surgical action. The abdomen was lavaged and drains inserted. Upon further conservative treatment with intravenous antibiotics, the patient showed quick recovery and was discharged on postoperative day 6.
Discussion:
With an incidence of 0.01%, perforation after diagnostic colonoscopy in children is very uncommon. The zone most frequently affected is the sigmoid colon due to direct penetration or indirect force due to flexure, or insufflation. Even without macroscopic perforation, the development of a tension pneumoperitoneum seems to be possible.
Conclusion:
Even though Colonoscopy in children is a safe tool, the treating physician must never underestimate the risks of such an intervention. Especially chronically altered intestine as in long-time persisting chronic inflammatory bowel disease demand special care and intensive observation of the patient after intervention.
