A 46-year-old woman underwent colonoscopy due to iron-deficiency
anemia. The patient had previously undergone an operation for ovarian
endometriomas. During this procedure, when the operator was advancing with the
endoscope to the sigmoid colon, the patient suddenly suffered a severe
abdominal pain. The exploration was suspended before perforation was
suspected.
Physical examination revealed hypogastric abdominal pain with
peritoneal irritation. The laboratory test was negative, and the abdominal
radiograph excluded pneumoperitoneum ([Fig. 1]).
Fig. 1 Abdominal radiograph
that excludes pneumoperitoneum.
The patient presented for clinical examination of acute abdominal
pain, so it was decided to make an emergency laparotomy. During this operation,
hemoperitoneum was found (150 mL of blood), two ruptures on the serosa
of the sigma with no alteration on the mucosa and submucosa were visualized,
and tubal vessel hemorrhage and adherences between the mesosalpinx and
mesosigma observed.
The incidence of serious complications due to colonoscopy is low;
the percentage of procedures for which complications require hospitalization is
0.21 %. Serious complications may be associated with stricture
dilation, polypectomy, elderly patients or inexperienced endoscopists
[1]. Hemoperitoneum is an uncommon complication of
colonoscopy [2]. The most frequent cause of
hemoperitoneum is splenic injury, but in the literature there are others causes
described, such as rupture of an epiploic appendix [3],
torsion of the mesenteric vein [2], necrosis of a small
intestinal leiomyosarcoma [4] or ovarian tumor rupture
[5]. As far as we know, this is the first case of
hemoperitoneum caused by rupture of tubal vessels with adherences of the
fallopian tube to the sigma.
Endoscopy_UCTN_Code_CPL_1AJ_2AB
