, Volume 33, Issue 6, pp 748-749
Date: 11 Jun 2008

Re: Colonic perforation during screening CT colonography using automated CO2 insufflation in an asymptomatic adult

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Dear Editor,

We would like to comment on the article by Bassett et al. [1] on a case of perforation occurred after automatic insufflation of CO2, in an asymptomatic patient with diverticular disease. The authors report that the insufflation was carried out by delivering approximately 11 L of CO2 with pressure at the equilibrium of 25 mmHg. We believe the delivery of such a large volume of gas must be carefully assessed in these patients. The presence of diverticula represented certainly a risk factor.

Diverticula are saclike protrusions in the colonic wall that develops as a result of herniation of the mucosa and the submucosa through “points of weakness”, where the vasa recta penetrate the muscular layer; they are more common in the sigmoid colon (in 5%–10% of cases the whole colon is involved). Diverticula represent closed chambers of the colonic lumen delimited by a thin mucosal wall with low resistance to stretching; therefore, in this specific case perforation more likely occurred w ...