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

  • Case Management and Clinical Consequences
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Abstract

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.

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Authors and Affiliations

  1. Clinic for Abdominal and Endocrine Surgery, Military Medical Academy, Crnotravska Street 17, 11000, Belgrade, Serbia

    Mile Ignjatović

  2. Clinic for Gastroenterology, Military Medical Academy, Crnotravska Street 17, 11000, Belgrade, Serbia

    Jasna Jović

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  1. Mile Ignjatović
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Correspondence to Mile Ignjatović.

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Ignjatović, M., Jović, J. Tension pneumothorax, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopic polypectomy: a case report and review of the literature. Langenbecks Arch Surg 394, 185–189 (2009). https://doi.org/10.1007/s00423-008-0309-3

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