Tension pneumothorax, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopic polypectomy: a case report and review of the literature

• Published in: Langenbeck's archives of surgery 2009, Vol.394 (1), p.185-189
• Main Authors: Ignjatović, Mile, Jović, Jasna
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; Case Management and Clinical Consequences; Chest Tubes; Colon, Sigmoid - surgery; Colonic Polyps - surgery; Colonoscopy - adverse effects; Electrosurgery; General Surgery; Humans; Iatrogenic Disease; Intestinal Perforation - diagnosis; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Pneumothorax - diagnosis; Pneumothorax - etiology; Pneumothorax - surgery; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - surgery; Reoperation; Retropneumoperitoneum - diagnosis; Retropneumoperitoneum - etiology; Retropneumoperitoneum - surgery; Sigmoid Neoplasms - surgery; Subcutaneous Emphysema - diagnosis; Subcutaneous Emphysema - etiology; Subcutaneous Emphysema - surgery; Thoracic Surgery; Traumatic Surgery; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-008-0309-3

Background and aims Colonoscopic complications are not frequent. Cases with colon perforations without the presence of pneumoperitoneum are very rare, and those with the development of tension pneumothorax are even rarer. The aim of this article was to present a unique case of the colon perforation during colonoscopic polypectomy. Case report We report a unique case of the colon perforation made between the two layers of the sigmoid mesocolon during colonoscopic polypectomy. The colon perforation had not been recognized during colonoscopic polypectomy, but the patient stayed at the hospital to be observed for the possible remitted bleeding after polypectomy. The colon perforation was followed by the development of the left-sided tension pneumothorax with massive mediastinum tending to move to the right, pneumoretroperitoneum, subcutaneous emphysema of the head, neck, and body, but without pneumoperitoneum. Tube drainage of the left pleural cavity was performed with release a great amount of air under pressure and then an urgent laparotomy when there was no free gas in the peritoneal cavity. After mobilizing the sigmoid colon, pneumoretroperitoneum and sigmoid colon perforation of 1.5 mm in diameter between two mesosigmoid layers were discovered. Partial sigmoidectomy was performed. A pathohistological examination verified a deepithelized area of 12 mm and a perforation of 1.5-mm diameter. The patient was dismissed as recovered 7 days after. Conclusion The patient was well prepared for colonoscopy, without other general diseases, and operated on quickly after the perforation (within 2 h from the perforation), without any significant retroperitoneum contamination. These are the factors for a favorable outcome of the treatment.