, Volume 24, Issue 4, pp 469-470
Date: 05 Sep 2008

Colonic gas detonation during endoscopic electrosurgery

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Dear Editor:

Colonic gas explosion is possible when diathermy is used in the presence of combustible concentrations of gases: oxygen ≥5%, hydrogen ≥4.1%, and methane ≥5%. Hydrogen and methane are the products of bacterial metabolism. Risk factors for combustible colonic gas concentrations are poor bowel preparation and bowel preparations such as mannitol that are sugars, which undergo bacterial degradation with the production of flammable gases. Good bowel preparation, use of non-substrate containing bowel preparation, suction of all pockets of colonic gas before diathermy and insufflation using carbon dioxide instead of air are preventative measures.

We experienced colonic gas explosion in a 71-year-old, male, Caucasian patient who underwent flexible sigmoidoscopy for ablation of a recurrent low rectal tubulo-villous adenoma following bowel preparation with a phosphate enema. The sigmoidoscope was passed to 40 cm with ease. The rectum and colon were found to be clean and colonic gas was ...

Shu-Li Ng wrote the case presentation. Oliver Anderson wrote the literature review. Shelagh J. Macleod edited the manuscript. Adrian P. Savage reviewed the manuscript.