A 47-year-old man underwent colonoscopy due to chronic diarrhea. A polypectomy of
three polyps of less than 7 mm in the sigmoid was performed without complications.
Shortly after the procedure, the patient complained of pain in the right iliac fossa,
which was increasing in intensity. Examination of the patient revealed peritoneal
irritation, leukocytosis, and elevation of C-reactive protein. Due to a suspicion
of perforation, an abdominal computed tomography (CT) scan was performed, which showed
pneumoperitoneum. At laparoscopy, multiple serosal lacerations were observed in the
cecum and ascending colon ([Fig. 1]), and hematomas in the transverse colon, with ap-parent intact colonic mucosa. Washing
of the peritoneal cavity was performed, and drains were placed. The patient’s postoperative
course was uneventful, and he was discharged 6 days after admission.
Fig. 1 Laparoscopic image showing serosal lacerations in the cecum and ascending colon.
Serosal tears without apparent rupture of the colon are complications that have been
reported following colonoscopy only in a few cases [1]
[2]
[3]. Serosal lacerations represent the earliest stage in rupture of the colon and occur
before any mucosal abnormality can be observed [4]. They have been attributed to the pressure of the air introduced through the colonoscope,
and to stretching of the colon wall [5]. In contrast to published cases, in this case, resection of the colon was not performed,
and the patient recovered favorably. Therefore, we conclude that serosal laceration
is usually a minor complication whose real incidence is unknown because probably it
happens without being noticed, with few symptoms, and with spontaneous resolution.
We believe that this complication should be included in the differential diagnosis
of patients who develop persistent pain after a colonoscopy, so that a conservative
treatment may be attempted, avoiding surgery.
Endoscopy_UCTN_Code_CPL_1AJ_2AH
