Abstract
Colonoscopy remains a widely used diagnostic and therapeutic procedure. However, like any invasive investigation it has the potential of complications; extraperitoneal perforation with pneumoretroperitoneum and subcutaneous emphysema being an extremely rare example. We report such a case in a57 year old woman who presented to the emergency department with abdominal pain and diffuse chest, neck and facial surgical emphysema following a routine colonoscopy with hot snarepolypectomy.
Highlights
About 1 in 20 people in the UK develop bowel cancer during their lifetime
Colonoscopy remains the gold standard investigation in the diagnosis of colon cancer and is routinely performed as part of the NHS bowel cancer screening programme. Complications such as perforation, bleeding and post-polypectomy syndrome may variably occur.The incidence of colonic perforation ranges from 0.016% to 0.2% following diagnostic colonoscopy and may be up to 5% following some colonoscopic interventions [1]
Colonic perforation presenting with pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema is extremely rare [2]
Summary
About 1 in 20 people in the UK develop bowel cancer during their lifetime. It remains the third most common cancer in the UK and the second leading cause of cancer deaths. Colonoscopy remains the gold standard investigation in the diagnosis of colon cancer and is routinely performed as part of the NHS bowel cancer screening programme. Complications such as perforation, bleeding and post-polypectomy syndrome may variably occur.The incidence of colonic perforation ranges from 0.016% to 0.2% following diagnostic colonoscopy and may be up to 5% following some colonoscopic interventions [1]. The CT scan showed possible pneumoperitoneum, very significant retropneumoperitoneum, pneumomediastinum with and upper thoracic, neck and facial surgical emphysema likely secondary to a bowel perforation in the proximal descending colon.Incidently a right upper lobe lung lesion suspicious for primary malignancy was noted with adjacent hilar lymph nodes but no evidence of distant metastases (Figures 2-4). The post-operative course was uneventful and she was discharged four days later
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