Crocetti Daniele, Fiori Enrico, Costi Umberto, Tarallo Mariarita, De Gori Antonietta, Cavallaro Giuseppe, De Toma Giorgio
Ann Ital Chir. 2019;90:201-207.
The purpose of this study is to determine the anatomica! aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy.
The review has been carried out according to PRISMA statement. The literature search included PubMed and Scopus database. The search string was "pneumothorax AND colonscopy".
A total of 36 papers met the inclusion criteria out of 57 non duplicate citations. Papers describing the clinical course of 36 patients with pneumothorax alter colonoscopy plus one case (our personal report), achieving a total of 37 patients available for analysis have been investigated. The review revealed a female predominance. 16 procedures were just diagnostic without biopsies, whereas in 21 cases procedures were performed with interventional maneuvers. The most common clinical feature of extraperitoneal colonic perforation was dyspnea in 31 patients (84%). Treatment included unilateral or bilateral chest drain, chest drain and laparotomy, only laparotomy or laparoscopìc approach, endoscopic treatment and conservative management was also reported.
Rarely, colonic perforation during colonoscopy can occur into the extraperitoneal space, thus leading to the passage and diffusion of air along the fasciai planes and large vessels, possibly causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. The combination of intraperitoneal and extraperitoneal perforation has also been reported.
Pneumothorax and tension pneumothorax following a colonoscopy is an extremely rare but severe and often lifethreatening complication. If the patient develops dyspnea and pneumoderma during or alter this procedure, a chest radiogram or thoracoabdominal CT should be taken for diagnostic purposes. Urgent treatment, starting with chest tube insertion(s) and laparotomy or laparoscopy could be lifesaving.
Colonic perforation, Colonoscopy, Pneumothorax.
本研究旨在确定常规结肠镜检查期间气胸发生的解剖学方面、机制、危险因素及适当处理方法。
本综述按照PRISMA声明进行。文献检索包括PubMed和Scopus数据库。检索词为“气胸 AND 结肠镜检查”。
57篇非重复引用文献中共有36篇符合纳入标准。已对描述36例结肠镜检查后气胸患者临床过程的文献加1例（我们的个人报告）进行了研究，共计37例患者可供分析。综述显示女性居多。16例检查仅为诊断性操作，未进行活检，而21例检查进行了介入操作。腹膜外结肠穿孔最常见的临床特征是31例患者（84%）出现呼吸困难。治疗方法包括单侧或双侧胸腔引流、胸腔引流及剖腹手术、仅剖腹手术或腹腔镜手术、内镜治疗以及保守治疗。
结肠镜检查期间结肠穿孔很少会发生在腹膜外间隙，从而导致空气沿筋膜平面和大血管穿行和扩散，可能引起腹膜后积气、纵隔积气、心包积气、气胸和皮下气肿。也有腹膜内和腹膜外穿孔同时存在的报道。
结肠镜检查后发生气胸和张力性气胸是一种极其罕见但严重且常危及生命的并发症。如果患者在该操作期间或之后出现呼吸困难和气肿，应进行胸部X线检查或胸腹CT以明确诊断。紧急治疗，首先进行胸腔插管及剖腹手术或腹腔镜手术可能挽救生命。
结肠穿孔；结肠镜检查；气胸
