Skip to main content
SpringerLink
Log in

Rectal Perforation during Computed Tomographic Colonography: Case Report and Literature Review

  • Case Report
  • Published:
Hellenic Journal of Surgery

Abstract

Backround

Computed tomographic colonography (CTC) is a minimally invasive imaging technique implemented primarily for the diagnosis of disease of the colon and rectum. Although serious complications are rare, rectal perforation is an unwanted event that may occur, as documented in a number of case reports. This case report is supplemented with a review of previously published cases.

Case Summary

We report the case of an 81-year-old male who underwent CTC after refusing a conventional colonoscopy for assessment of left lower quadrant abdominal pain. Excessive rectal bleeding was observed on completion of the CTC, and rectal perforation was confirmed by the finding of perirectal air on the CT scan. The perforation caused hypogastric pain, discomfort and hematochezia. The treatment was conservative, consisting of antibiotics, no oral intake and bowel rest. A literature review was conducted and the characteristics of previously reported events of perforation during CTC were summarized.

Conclusion

Although rare, bowel perforation may occur during CTC. Awareness of this complication will lead to prompt diagnosis and timely management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yee J, Weinstein S, Morgan T, et al. Advances in CT colonography for colorectal cancer screening and diagnosis. J Cancer 2013;4:200–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lefere P, Dachman AH, Gryspeerdt S. Computed tomographic colonography: Clinical value. Abdom Imaging 2007;32:541–51.

    Article  PubMed  Google Scholar 

  3. Spada C, Stoker J, Alarcon O, et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol 2015;25:331–45.

    Article  PubMed  Google Scholar 

  4. Pendsé DA, Taylor SA. Complications of CT colonography: A Review. Eur J Radiol 2013;82:1159–65.

    Article  PubMed  Google Scholar 

  5. Iafrate F, Iussich G, Correale L, et al. Adverse events of computed tomography colonography: An Italian National Survey. Dig Liver Dis 2013;45:645–50.

    Article  PubMed  Google Scholar 

  6. Burling D, Halligan S, Slater A, et al. Potentially serious adverse events at CT colonography in symptomatic patients: National survey of the United Kingdom. Radiology 2006;239:464–71.

    Article  PubMed  Google Scholar 

  7. Bellini D, Rengo M, De Cecco CN, et al. Perforation rate in CT colonography: A systematic review of the literature and meta-analysis. Eur Radiol 2014;24:1487–96.

    Article  PubMed  Google Scholar 

  8. Reumkens A, Rondagh EJA, Bakker CM, et al. Post-Colonoscopy Complications: A Systematic Review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 2016;111:1092–101.

    Article  PubMed  Google Scholar 

  9. Day LW, Kwon A, Inadomi JM, et al. Adverse events in older patients undergoing colonoscopy: A systematic review and meta-analysis. Gastrointest Endosc 2011;74:885–96.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kato T, Muroya T, Goda T, et al. Iatrogenic Colonic Perforation due to computed tomographic colonography. Case Rep Gastroenterol 2015;9:171–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pickhardt PJ. Incidence of colonic perforation at CT colonography: Review of existing data and implications for screening of asymptomatic adults. Radiology 2006;239:313–6.

    Article  PubMed  Google Scholar 

  12. Atalla MA, Rozen WM, Niewiadomski OD, et al. Risk factors for colonic perforation after screening computed tomographic colonography: A multicentre analysis and review of the literature. J Med Screen 2010;17:99–102.

    Article  PubMed  Google Scholar 

  13. Sosna J, Blachar A, Amitai M, et al. Colonic perforation at CT colonography: Assessment of risk in a multicenter large cohort. Radiology 2006;239:457–63.

    Article  PubMed  Google Scholar 

  14. Kamar M, Portnoy O, Bar-Dayan A, et al. Actual Colonic Perforation in Virtual Colonoscopy: Report of a Case. Dis Colon Rectum 2004;47:1242–6.

    Article  PubMed  Google Scholar 

  15. Coady-Fariborzian L, Angel LP, Procaccino JA. Perforated colon secondary to virtual colonoscopy: Report of a case. Dis Colon Rectum 2004;47:1247–9.

    Article  PubMed  Google Scholar 

  16. Young BM, Fletcher JG, Earnest F, et al. Colonic perforation at CT colonography in a patient without known colonic disease. Am J Roentgenol 2006;186:119–21.

    Article  Google Scholar 

  17. Belo-Oliveira P, Curvo-Semedo L, Rodrigues H, et al. Sigmoid colon perforation at ct colonography secondary to a possible obstructive mechanism: Report of a Case. Dis Colon Rectum 2007;50:1478–80.

    Article  PubMed  Google Scholar 

  18. Halligan S, Wooldrage K, Dadswell E, et al. Computed tomographic colonography versus barium enema for diagnosis of colorectal cancer or large polyps in symptomatic patients (SIGGAR): A multicentre randomised trial. Lancet Lancet. 2013;381(9873):1185–93.

    Article  PubMed  Google Scholar 

  19. Zafar HM, Harhay MO, Yang J, et al. Adverse events following computed tomographic colonography compared to optical colonoscopy in the elderly. Prev Med Reports 2014;1:3–8.

    Article  Google Scholar 

  20. Zukiwskyj M, Arafat Y. Case Report: Rectal perforation during CT colonography. F1000Res 2016;5:299.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Atalla MA, Rozen WM, Master M, et al. Colonic perforation during ‘virtual’ CT colonography. J Gastroenterol Hepatol 2009;24:1800.

    Article  PubMed  Google Scholar 

  22. Teo JY, Low OW, Ho KS. Colonic perforation caused by direct trauma during computed tomographic colonography performed via end colostomy. Singapore Med J 2011;52:e248–50.

    CAS  PubMed  Google Scholar 

  23. Triester SL, Hara AK, Young-Fadok TM, et al. Colonic perforation after computed tomographic colonography in a patient with fibrostenosing Crohn’s disease. Am J Gastroenterol 2006;101:189–92.

    Article  PubMed  Google Scholar 

  24. Atkin W, Dadswell E, Wooldrage K, et al. Computed tomographic colonography versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): A multicentre randomised trial. Lancet 2013;381(9873):1194–202.

    Article  PubMed  Google Scholar 

  25. Nagata K, Takabayashi K, Yasuda T, et al. Adverse events during CT colonography for screening, diagnosis and pre-operative staging of colorectal cancer: A Japanese national survey. Eur Radiol 2017;27:4970–8.

    Article  PubMed  Google Scholar 

  26. Wong SH, Wong VWS, Sung JJY. Virtual colonoscopy-induced perforation in a patient with Crohn’s disease. World J Gastroenterol 2007;13:978–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bassett JT, Liotta RA, Barlow D, et al. Colonic perforation during screening CT colonography using automated CO2 insufflation in an asymptomatic adult. Abdom Imaging 2008;33:598–600.

    Article  PubMed  Google Scholar 

  28. Bowles CJA, Leicester R, Romaya C, et al. A prospective study of colonoscopy practice in the UK today: Are we adequately prepared for national colorectal cancer screening tomorrow? Gut 2004;53:277–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Aristotle University of Thessaloniki, Priamou 10, Kato Toumpa, 54453, Thessaloniki, Greece

    Ioannis A. Ziogas

  2. 1st Department of Surgery, Papageorgiou University Hospital, Thessaloniki, Greece

    D. I. Athanasiadis, A. Tooulias, G. Tsoulfas, C. P. Spanos & V. N. Papadopoulos

Authors
  1. Ioannis A. Ziogas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. I. Athanasiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Tooulias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Tsoulfas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. P. Spanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. N. Papadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ioannis A. Ziogas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ziogas, I.A., Athanasiadis, D.I., Tooulias, A. et al. Rectal Perforation during Computed Tomographic Colonography: Case Report and Literature Review. Hellenic J Surg 91, 49–56 (2019). https://doi.org/10.1007/s13126-019-0505-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-019-0505-3

Key words

Search

Navigation