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Delayed mid-ileal perforation secondary to acute-on-chronic ischaemia after a diagnostic colonoscopy
Abstract:
Perforation occurring at a remote site of the bowel after diagnostic colonoscopy is rare. A 61-year-old man presenting with bloody diarrhoea underwent colonoscopy. A dynamic ileus developed in less than 1 day, and mid-ileal perforation occurred 7 days after the procedure. It is suggested that high air pressure during colonoscopy further compromised the reduced blood flow in the mid-ileum, which had underlying chronic ischaemia, leading to perforation. Our patient constitutes the first reported case of small-bowel perforation after colonoscopy due to pre-existent ileal ischaemia.
Insights
Remote small-bowel perforation after colonoscopy is rare. This case highlights a potential risk in patients with pre-existing ileal ischemia, where high colonoscopy air pressure may lead to perforation.
Area of Science:
- Gastroenterology
- Surgical complications
Background:
- Diagnostic colonoscopy is a common endoscopic procedure.
- Bowel perforation is a rare but serious complication of colonoscopy.
- Remote perforations, distant from the colonoscope's passage, are exceptionally uncommon.
Observation:
- A 61-year-old male presented with bloody diarrhea and underwent diagnostic colonoscopy.
- Within 24 hours, he developed symptoms of dynamic ileus.
- Mid-ileal perforation was diagnosed seven days post-procedure.
Findings:
- The patient had underlying chronic ischemia of the mid-ileum.
- High insufflation pressure during colonoscopy is hypothesized to have exacerbated the compromised blood flow.
- This led to ischemic necrosis and subsequent perforation at a remote small bowel site.
Implications:
- This case represents the first reported instance of small-bowel perforation following colonoscopy attributed to pre-existent ileal ischemia.
- Clinicians should consider the risk of remote bowel perforation in patients with compromised mesenteric blood flow.
- Further research may be warranted to identify risk factors and optimize colonoscopy techniques to prevent such rare complications.