Colonic Perforation at CT Colonography in a Patient Without Known Colonic Disease

Abstract

2Department of Radiology, Mayo Clinic Rochester, Mayo East 2-B, 200 First St. SW, Rochester, MN 55905. Address correspondence to J. G. Fletcher. T colonography, or virtual colonoscopy, is now routinely used as a full structural examination of the colorectum following incomplete endoscopy [1] and in patients with elevated risk for complications during endoscopy or with aversion to endoscopy. CT colonography has demonstrated performance on par with optical colonoscopy in the screening of asymptomatic patients for adenomatous polyps in some hands [2] and has performed superiorly compared with nonendoscopic alternatives [3]. Optimal colonic inflation is essential to a high-quality CT colonography examination. Given the speed of image acquisition and reconstruction of MDCT scanners, patients must tolerate maximum inflation for only a few seconds, as opposed to endoscopy and barium enema, in which the colon remains inflated for much longer periods of time. Nevertheless, colonic insufflation is known to result in perforation, ranging from approximately 0.004–0.01% of cases for double contrast barium enema [4, 5] to 0.07–0.19% of cases for colonoscopy [6, 7]. To date, thousands of patients have undergone CT colonography without complications. Two cases of colonic perforation at CT have recently been reported in patients with known colonic disease [8, 9]. We report a case of perforation following CT colonography in a patient without known colonic disease.