An 80-year-old male patient underwent sigmoidoscopy to perform polypectomy. A complete
colonoscopy 4 months before, had shown a 2 cm sessile, ulcerated polyp in the sigmoid
colon, which was not resected. By this time, a stenotic mass lesion was found at the
same location. Biopsies were taken and exploration finished, and the patient was referred
for surgery with the diagnosis of colorectal carcinoma. Six hours after sigmoidoscopy,
the patient returned to the hospital with acute abdominal pain and tenderness. X-ray
showed pneumoperitoneum, undergoing emergency laparotomy. A 15 cm rupture along the
cecum wall was observed. No signs of perforation were seen in the sigmoid area. Subtotal
colectomy was carried out. Six months later, the patient is alive and being followed
up by both surgeons and oncologists. The final diagnosis was “moderately differenced
adenocarcinoma infiltrating mesenteric adipose tissue, with peritumoral and mesenteric
lymph nodes extension”.
Colon perforation is an uncommon complication during diagnostic colonoscopy. The rate
is as low as 0.02 % of all cases [1]. Perforation is more likely to occur during therapeutic procedures [2], or if an underlying colonic disease is present. Another unusual mechanism is barotrauma
caused by excessive insufflation and retention of air [3]. Our case might be included in the latter group: no therapeutic intervention was
made, and no concomitant disease was present. The only underlying factor might have
been the patient’s age, but colonoscopy appears to be safe in the elderly [4]. The presence of a straightened colon lumen could have promoted air accumulation
and blocked its elimination, inducing excessive pressure at the right colon, causing
cecal perforation. The management of these perforations is, in most cases, surgical.
However, a conservative approach can be taken in selected cases. In our patient, surgical
therapy was decided because of the peritoneal irritation and with the intention of
curing the sigmoid neoplasia.
Endoscopy_UCTN_Code_CPL_1AJ_2AB
