A Case of Post-Colonoscopy Intra/Extraperitoneal Free Air: Is Surgical Treatment Always Necessary?

Abstract

Colonoscopy-related colonic perforation may occur through pneumatic or mechanical impact, or due to various therapeutic procedures. Mucosal herniation may also develop because of the increase in post-air insufflation pressure. This condition may render the mucosa air-permeable without a distinct focal perforation point.
 A 63-year-old female patient, who had had surgery for malign rectal neoplasm five years before and followed-up for radiation proctitis, presented to the emergency department three days after she had control colonoscopy with complaints of a gradually deteriorating facial and cervical swelling along with respiratory distress that developed a day after the procedure. The results of the patient’s analyses revealed that she had colonoscopy-related pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, cervical and facial subcutaneous emphysema. Medical follow-up was planned for the patient since there were no signs of peritonitis in her physical examination, her overall condition was well, and because a long time had passed after the procedure. The patient was discharged after a two-day follow-up with no problems.
 Colonoscopy-related intraperitoneal or extraperitoneal free air can both be seen immediately during the procedure and it can develop a long time after the procedure as well. Unnecessary surgical procedures can be prevented through medical follow-up under close monitoring in such patients particularly if they do not have peritonitis signs or symptoms and their overall condition is well.