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KMID : 0352120120280010010
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Journal of Kyung Hee University
2012 Volume.28 No. 1 p.10 ~ p.13
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Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, Pneumopericardium, Pneumothoraces and Subcutaneous Emphysema Complicating Sigmoidoscopy: Report of a Case
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Cho Kyu-Seok
Youn Hyo-Chul
Kim Ho-Yeun
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Abstract
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A 78-year old man underwent a colonoscopy, at the another hospital which showed a diverticulum between descending and sigmoid colon. After sigmoidoscopic excision of diverticulum, Subcutaneous emphysema developed from the face to abdomen. Systolic blood pressure fell down to 70 mmHg in the local clinic. So he referred to our hospital for further evaluations and treatment. On. arriral at the emergency clinic, Intial chest P-A and computed tomography of the thorax in lung setting and of the abdomen showed extensive subcutaneous emphysema, pneunomediastinum, bilateral pneumothoraces, free intra peritoneal air and retroperitoneal air. so, we suspected perforated colon due to the colonoscopic procedures. so we decided to operate the patient. The videoassisted transabdominal laparoscopic operation
was performed on the same day of the colonoscopy. The operative field revealed air in the subserosal space of the sigmoid colon and Pneumoperitoneum with diffuse peritonitis. We also detected perforated site and Hemoclip in the
descending and sigmoid colon junction. Massive saline solution irrigated in the Peritoneal cavity. Fasciotomy for the subcutaneous emphysema of the neck and entire anterior and lateral chest wall was done on the lst day of the admission, The chest tube insertion for the left pneumothorax was done on the same day. The patient was discharged after 2 Weeks
staying in the hospital.
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KEYWORD
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Subcutaneous emphysema, Colonoscopy, Pneumomediastinum, Pneumothorax, Colon Perforation
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