Kipple John C
Nurse Anesthesia Program, Woldford College, Naples, FL, USA.
AANA J. 2010 Dec;78(6):462-7.
A 78-year-old man presented preoperatively with severe abdominal pain, dyspnea, and subcutaneous emphysema in his face, neck, and chest approximately 8 hours after colonoscopy with a sigmoid polypectomy. A pneumoperitoneum, free air in the mesentery, pneumoretroperitoneum, pneumomediastinum, and bilateral pneumothoraces were diagnosed using radiography and computed axial tomography. He emergently underwent an exploratory laparotomy with colostomy following bilateral chest tube placement. At laparotomy, a perforation of the posterior sigmoid colon was identified at the site of earlier polypectomy. The patient remained intubated and mechanically ventilated for 3 days postoperatively. Perforations of the colon during colonoscopies are the most serious complication of the procedure. Continued insufflation of air or carbon dioxide into a perforated colon can result in extraluminal gas that can result in life-threatening tension pneumothoraces. This case examines the consequences of colonic perforation and the anesthetic management for the definitive surgical treatment of a posterior sigmoid wall perforation. Anesthesia providers' awareness of the risk factors for colonic perforation due to colonoscopy, early signs and symptoms of perforation, and knowledge of the surgical and anesthetic management of perforation could lead to early recognition and intervention and likely to improved patient outcomes.
一名78岁男性在乙状结肠息肉切除术后约8小时进行结肠镜检查，术前出现严重腹痛、呼吸困难，面部、颈部和胸部皮下气肿。通过X线摄影和计算机断层扫描诊断为气腹、肠系膜游离气体、腹膜后积气、纵隔积气和双侧气胸。在双侧放置胸管后，他紧急接受了剖腹探查并进行了结肠造口术。剖腹手术时，在先前息肉切除部位发现乙状结肠后壁穿孔。患者术后持续插管并机械通气3天。结肠镜检查期间结肠穿孔是该手术最严重的并发症。向穿孔的结肠持续注入空气或二氧化碳会导致腔外气体，进而导致危及生命的张力性气胸。本病例探讨了结肠穿孔的后果以及乙状结肠后壁穿孔确定性手术治疗的麻醉管理。麻醉医生了解结肠镜检查导致结肠穿孔的危险因素、穿孔的早期体征和症状，以及穿孔的手术和麻醉管理知识，可能会实现早期识别和干预，并可能改善患者预后。
