title: Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy.
abstract: Both intraperitoneal and extraperitoneal colonic perforations have been reported after colonoscopy; however, cases with combined types of perforation are rare. We present the case of a 55-year-old man with a history of Crohn disease who complained of acute abdominal pain after a diagnostic colonoscopy. Abdominal computed tomography scan showed extensive pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and leftsided pneumothorax. Exploratory laparotomy was performed, and the patient underwent subtotal colectomy and end ileostomy with placement of a left-sided chest drain for the left-sided pneumothorax. The patient was discharged home postoperatively in good condition. As the utility of colonoscopy continues to broaden, its complications will also be more common. Whereas intraperitoneal perforation is a known and not uncommon complication, extraperitoneal perforation is an uncommon complication. Combined intraperitoneal and extraperitoneal perforation is extremely rare, with only a few cases reported in the literature. Early diagnosis and operative management resulted in a satisfactory outcome in this particular case.
authors.affiliation: Department of General Surgery, Kaiser Permanente, 9961 Sierra Ave, Fontana, CA 92335, USA. ahmed.dehal@gmail.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Dehal
authors.affiliation: Department of General Surgery, Kaiser Permanente, Fontana, CA, USA.
authors.forename: Deron J
authors.initials: DJ
authors.lastname: Tessier
mesh_terms: D012809:Colon, Sigmoid / Q000293:injuries*; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects*; D003424:Crohn Disease / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity; D014057:Tomography, X-Ray Computed