Weng Emily, Valencia Damian N, Krudy Zoltan A, Ali Median
Internal Medicine, Kettering Medical Center, Kettering, USA.
Internal Medicine, Kettering Medical Center, Dayton, USA.
Cureus. 2020 Mar 2;12(3):e7162. doi: 10.7759/cureus.7162.
Colonic perforation is an uncommon but known and feared complication of colonoscopy, which carries a high mortality rate. We present an uncommon case of extensive intra- and extraperitoneal air following colonic perforation in a patient undergoing inpatient colonoscopy for evaluation of unintentional weight loss and constipation. During colonoscopy, a splenic flexure stricture was identified and dilated. Postprocedural hemodynamic instability prompted further imaging which revealed pneumoperitoneum, bilateral pneumothorax, pneumomediastinum, pneumopericardium, and severe subcutaneous emphysema. Emergent exploratory laparotomy found perforation of the proximal transverse colon which required resection and transverse colostomy placement. The patient also underwent bilateral chest tube placement and was treated with antibiotics for peritonitis. The patient was eventually diagnosed with Crohn's disease and discharged to an extended care facility with outpatient follow-up. Extraperitoneal colonic perforations are fairly rare, and to our knowledge, we present the most severe case that has been published in recent years.
结肠穿孔是结肠镜检查中一种不常见但已知且令人恐惧的并发症，其死亡率很高。我们报告了一例不常见的病例，一名因非故意体重减轻和便秘而接受住院结肠镜检查的患者，在结肠穿孔后出现广泛的腹腔内和腹腔外积气。在结肠镜检查期间，发现并扩张了脾曲狭窄。术后血流动力学不稳定促使进一步影像学检查，结果显示有气腹、双侧气胸、纵隔气肿、心包积气和严重的皮下气肿。急诊剖腹探查发现近端横结肠穿孔，需要进行切除并放置横结肠造口术。患者还接受了双侧胸腔闭式引流，并因腹膜炎接受抗生素治疗。该患者最终被诊断为克罗恩病，出院后转至长期护理机构并进行门诊随访。腹膜外结肠穿孔相当罕见，据我们所知，我们报告的是近年来已发表的最严重的病例。
