Presentation
Worsening abdominal discomfort and distension post colonoscopy.
Patient Data
Air under the diaphragm is in keeping with the pneumoperitoneum.
Streaks of air outline the left heart border suggestive of pneumopericardium.
Scout view: A large amount of pneumoperitoneum, oval-shaped air lucency outlined the whole peritoneum and falciform ligament giving the appearance of football sign and falciform ligament sign.
Continuous diaphragm sign noted.
Air outlined both kidneys is in keeping with pneumoretroperitonuem.
Streaks of gas at the right lower quadrant, suspicious of subcutaneous emphysema.
CT:
Extensive pneumoperitoneum with falciform ligament sign.
A moderate amount of bilateral pneumoretroperitoneum.
Free gas is also in the subcutaneous fat of the right lower abdomen, right scrotum, retroperitoneum, mediastinum, chest wall and pericardium.
No rectal contrast extravasation from the lower colon to suggest a direct CT sign of large perforation.
Annotated images showing the radiographic signs of pneumoperitoneum, pneumoretroperitoneum and pneumopericardium.
Case Discussion
The patient just had a colonoscopy and multiple biopsies taken for the polyps at descending colon. Persistent abdominal discomfort and distension raise high suspicion of perforation as a complication of post-colonoscopy. This is proven with erect chest radiograph, CT scan as well as during exploratory laparotomy. Intraoperatively, extensive pneumoperitoneum but unable to detect obvious colonic perforation, suspicious of micro-perforation.
Bowel perforation is known complications post-optical colonoscopy.
Unable to process the form. Check for errors and try again.