Pneumomediastinum and subcutaneous emphysema as complication of colonoscopy

Abstract

An intestinal perforation in the course of a diagnostic colonoscopy is an infrequent complication, but it has been described. In general, it does not develop greater consequences, except local damage. This study presents a case of pneumomediastinum and subcutaneous emphysema after an accidental perforation of the colon in the course of a colonoscopy. A 64-year-old female patient was ordered a colonoscopy since the result of an occult blood exam during an active investigation was positive. While performing the intervention the doctor interrupted it when noticing a small amount of bleeding that suggested a perforation of the colon and moved the patient to the emergency department of general surgery. The assessment of the patient’s clinical state and the running the corresponding investigations, both humoral and radiological, indicated the presence of a pneumoperitoneum, pneumomediastinum, as well as a subcutaneous emphysema embracing fascia, neck and the upper third of the thorax. The patient is emergently taken to the operating room. A laparotomy is performed confirming a pinhole perforation in the sigmoid colon which was treated with a single layer suturing. After the anesthetic recovery the patient was transferred to the intensive care unit. During the immediate postoperative period the pneumomediastinum disappeared totally, and the subcutaneous emphysema progressively. The patient progressed satisfactorily and was transferred to an inpatient ward, being discharged from the hospital after ten days without complications. Nowadays the patient is in a perfect health state and totally asymptomatic.