Colonoscopy-Associated Pneumothorax

Abstract

Purpose: Colonoscopy is associated with very few complications. We present a unique case of a pneumothorax in a patient that was found in association with an elective diagnostic colonoscopy. Methods: A 30 year old, otherwise healthy woman, was referred by her primary care physician to us for evaluation of chronic constipation. She complained of constipation associated with occasional abdominal pain and nausea. She had to strain with every bowel movement and use laxatives regularly. She had a caesarian section around 14 years ago. She had a 12 pack-year history of smoking with occasional use of alcohol, and no use of opiates or any other recreational drugs. She was found to have a body mass index of 27.4 and a normal physical examination except for a small external hemorrhoid in the perianal region. An elective diagnostic colonoscopy was done for evaluation of chronic constipation of unknown etiology. Results: During the procedure, the recto-sigmoid junction was found to be acutely angled and hypertrophied necessitating a switch from a pediatric colonoscope (PCF-160 Olympus video colonoscope) to an upper endoscope (Olympus GIF-QX140). The colon proximal to the recto-sigmoid junction was dilated and tortuous. Following the procedure, the patient complained of abdominal pain, distension and was not able to pass flatus. A computed tomography (CT) of the abdomen showed no evidence of colon perforation, however, showed a moderate right-sided pneumothorax. The pneumothorax gradually increased in size over the next few days which required insertion of a chest-tube. Chest X-rays following the tube placement showed rapid re-expansion of the lung with resolution of the pneumothorax. Conclusion: The description of pneumothorax in association with colonoscopy is restricted to only a few case reports. The mechanism of pneumothorax in this case is unclear with the absence of colon perforation and pneumoperitoneum, unlike other cases reported. Pneumothorax, especially tension pneumothorax, could be life-threatening and should be promptly recognized.Figure: The arrows delineate the white line associated with the pneumothorax.