A rare case of iatrogenic pneumothorax, pneumomediastinum and pneumoperitoneum following colonoscopy

초록

Since colonoscopy was first introduced into clinical field in the 1960s, it has now been used as the most useful technical method for the diagnosis and treatment of various colorectal disease. Colonoscopy remains a relatively safe procedure, but rising using of colonoscopy, diagnostic or therapeutic, has led to a higher prevalence of iatrogenic colon perforation. We report here a rare case of pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopic perforation of the ascending colon. A previously healthy 52-year-old male was coming to our emergency department with painful abdominal bloating and shortness of breath. He had undergone a colonoscopy for removal of colon polyp at a local medical clinic prior to this visit. On physical examination, he was tachypneic with a respiratory rate of 28 breaths per minute, and hypoxic with a saturation of partial pressure oxygen (SpO2) of 89% on room air. The patient had a blood pressure of 133/86 ㎜Hg, a heart rate of 98 beats per minute, and a body temperature of 37.9°C. Auscultation of the lungs revealed diminished breath sound on the right hemithorax. Palpation of right upper quadrant of abdomen and right lower extremity demonstrated eliciting a characteristic tissue paper feeling beneath the fingers and these were suspected by the presence of subcutaneous emphysema. Abdominal examination revealed a rigid abdomen with a mild periumbilical tenderness and rebound tenderness. A computed tomography of chest, abdomen, and pelvis showed multiple metal endoclips in the distal ascending colon, right pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema (Figure 1). A chest tube was inserted into the right pleural cavity and an urgent exploratory laparoscopy was performed, which revealed air in the subserosa and mesocolon of the distal ascending colon, with localized peritonitis in the ant