Pneumothorax, pneumomediastinum, pneumoperitoneum and extensive subcutaneous emphysema resulting from endoscopic mucosal resection secondary to colonoscopy: A case report

Yang,Jun; Liu,Wei  Qing; Dong,Jian; Wen,Zheng  Qi; Zhu,Zhu; Li,Wen  Liang

doi:10.3892/ol.2016.4302

Pneumothorax, pneumomediastinum, pneumoperitoneum and extensive subcutaneous emphysema resulting from endoscopic mucosal resection secondary to colonoscopy: A case report

Authors:
- Jun Yang
- Wei Qing Liu
- Jian Dong
- Zheng Qi Wen
- Zhu Zhu
- Wen Liang Li
View Affiliations

Affiliations: Department of Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China, Department of Internal Medicine‑Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China, Department of Internal Medicine‑Oncology, Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650106, P.R. China
Published online on: March 2, 2016 https://doi.org/10.3892/ol.2016.4302
Pages: 2763-2767
Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Rectal perforation is an unusual complication of therapeutic colonoscopy. The present study reports the case of a patient with a rare manifestation of pneumothorax, pneumomediastinum, pneumoperitoneum and extensive subcutaneous emphysema that resulted from an endoscopic mucosal resection following a colonoscopy of the rectum. Only 3 cases of colonic perforation and 1 case of rectal perforation have been described previously, of which the clinical diagnoses and treatments were varied, and no results of follow‑up studies were reported. In the present study, dyspnea and neck swelling were acute signs of extraluminal air that resulted from rectal perforation. Computed axial tomography was an effective diagnosis method, and is recommended for the early recognition of colorectal perforation. Appropriate management and a close follow-up are crucial for optimal results.

View Figures

View References

1	Hurlstone DP, Sanders DS, Cross SS, Adam I, Shorthouse AJ, Brown S, Drew K and Lobo AJ: Colonoscopic resection of lateral spreading tumours: A prospective analysis of endoscopic mucosal resection. Gut. 53:1334–1339. 2004. View Article : Google Scholar : PubMed/NCBI
2	Park SJ: Tips and tricks for better endoscopic treatment of colorectal tumors: Usefulness of cap and band in colorectal endoscopic mucosal resection. Clin Endosc. 46:492–494. 2013. View Article : Google Scholar : PubMed/NCBI
3	Fu KI, Sano Y, Kato S, Fujii T, Sugito M, Ono M, Saito N, Kawashima K, Yoshida S and Fujimori T: Pneumoscrotum: A rare manifestation of perforation associated with therapeutic colonoscopy. World J Gastroenterol. 11:5061–5063. 2005. View Article : Google Scholar : PubMed/NCBI
4	Marwan K, Farmer KC, Varley C and Chapple KS: Pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema following diagnostic colonoscopy. Ann R Coll Surg Engl. 89:W20–W21. 2007. View Article : Google Scholar : PubMed/NCBI
5	Zeno BR and Sahn SA: Colonoscopy-associated pneumothorax: A case of tension pneumothorax and review of the literature. Am J Med Sci. 332:153–155. 2006. View Article : Google Scholar : PubMed/NCBI
6	Denadai R, Medeiros CC, Toledo AP, Carvalho AF Jr and Muraro CA: Rectal perforation after colonoscopic polypectomy presented as subcutaneous emphysema, pneumomediastinum and pneumoretroperitoneum successfully treated conservatively in an elderly adult. J Am Geriatr Soc. 61:1433–1435. 2013. View Article : Google Scholar : PubMed/NCBI
7	Endo S, Hirasaki S, Doi T, Endo H, Nishina T, Moriwaki T, Nakauchi M, Masumoto T, Tanimizu M and Hyodo I: Granular cell tumor occurring in the sigmoid colon treated by endoscopic mucosal resection using a transparent cap (EMR-C). J Gastroenterol. 38:385–389. 2003. View Article : Google Scholar : PubMed/NCBI
8	Kim HH, Park SJ, Lee SH, Park HU, Song CS, Park MI and Moon W: Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: Analysis of 100 cases. Dig Endosc. 24:159–163. 2012. View Article : Google Scholar : PubMed/NCBI
9	Bakker J, van Kersen F and Spruyt Bellaar J: Pneumopericardium and pneumomediastinum after polypectomy. Endoscopy. 23:46–47. 1991. View Article : Google Scholar : PubMed/NCBI
10	Lohsiriwat V: Colonoscopic perforation: Incidence, risk factors, management and outcome. World J Gastroenterol. 16:425–430. 2010. View Article : Google Scholar : PubMed/NCBI
11	Castellví J, Pi F, Sueiras A, Vallet J, Bollo J, Tomas A, Verge J, Caballero F, Iglesias C and De Castro J: Colonoscopic perforation: Useful parameters for early diagnosis and conservative treatment. Int J Colorectal Dis. 26:1183–1190. 2011. View Article : Google Scholar : PubMed/NCBI
12	Ho HC, Burchell S, Morris P and Yu M: Colon perforation, bilateral pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema complicating endoscopic polypectomy: Anatomic and management considerations. Am Surg. 62:770–774. 1996.PubMed/NCBI
13	La Torre M, Velluti F, Giuliani G, Di Giulio E, Ziparo V and La Torre F: Promptness of diagnosis is the main prognostic factor after colonoscopic perforation. Colorectal Dis. 14:e23–e26. 2012. View Article : Google Scholar : PubMed/NCBI
14	Donatelli G, Vergeau BM, Dumont JL, Altmann C, Dritsas S, Dhumane P, Tuszynski T and Meduri B: Delayed successful treatment of iatrogenic colon perforation using an over-the-scope clip. Endoscopy. 46(Suppl 1): E285–E286. 2014.PubMed/NCBI
15	Xiao YF, Bai JY, Yu J, Lin XL, Zhao XY, Yang SM and Fan CQ: Endoscopic treatment of delayed colon perforation: The enteroscopy overtube approach. Endoscopy. 46:503–508. 2014. View Article : Google Scholar : PubMed/NCBI