Abstract
IntroductionA perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems.Case presentationWe report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later.ConclusionAcute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.
Highlights
A perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose
Acute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation
We report a life threatening case of primary acute abdominal compartment syndrome (AACS) resulting from iatrogenic colonic perforation during a diagnostic colonoscopy
Summary
Colonic perforation due to colonoscopy rarely occurs but still remains a major complication with a high rate of morbidity and mortality and often needs surgical management [1]. Case presentation We report the case of a 60-year-old Moroccan man admitted for the surgical management of a high rectal adenocarcinoma He had no past history of cardiovascular or pulmonary disease, with no recent surgery, and was classified according to the American Society of Anesthesiology (ASA) as ASA II. During the first five minutes of the procedure, the endoscopist reported some difficulties, but no signs of perforation, that caused a little discomfort and pain to our patient, which was managed with two 1 mg intravenous bolus injections of midazolam This allowed our patient to remain awake and follow the endoscopist’s instructions. A diagnosis of AACS due to iatrogenic colonic perforation was made and our patient managed While he was in the intensive care unit, no intra-abdominal pressure measure was realized. He returned after two months for the closure of the ileostomy and remains free of disease three years later
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