Two Cases of Colonic Perforation Following Lacerations Caused by Gas Insufflation During Colonoscopy

Introduction: Most of major serious colonoscopy complications, including perforation and hemorrhage, are caused by the invasive procedure and/or the violent scope manipulation. The present paper reported two cases of colonic perforation following lacerations caused by gas-insufflation during colonoscopy. Case 1: A 80-year-old female, who was prescribed lansoprazole for reflux esophagitis, underwent colonoscopy because of chronic diarrhea. Endoscopy showed mucosal atrophy with white coat in the colon. During progress in carbon dioxide insufflation, multiple lacerations appeared spontaneously in the colon. CT on the followed day indicated a lot of free air and colonic wall swelling without any clue of the colon perforation site. The patient had no abdominal symptoms and no signs of peritonitis on the physical examination and blood tests. The conservative therapy with fasting and antibiotics recovered the patient uneventfully. The histopathological assessment of the biopsy specimens showed thickening of the subepithelial collagen layer, which was consistent with the collagenous colitis. Cessation of lansoprazole improved the diarrhea immediately. Capsule colonoscopy in 6 weeks after the colonoscopy demonstrated that the white coat and mucosal atrophy were subsided and that the lacerations were cicatrized. Case 2: A 60-year-old female, who had a double-barrel stoma in the transverse colon, underwent colonoscopy in the 10 years postoperative screening. The scope was inserted through the stoma to the anus. The examination was suspended due to the longitudinal lacerations in the areas without passing the endoscope. After the colonoscopy, the patient complained of abdominal pain and fever, and CT showed intestinal edema and free air along the examined colon. The patient was diagnosed as the colon perforation-induced peritonitis caused by the wall lacerations with gas insufflation in the unused colon. Conservative therapy with fasting and antibiotics recovered the patients. CT on the 9th day demonstrated disappearance of the free air. Conclusion: Colonic perforations following lacerations caused by gas insufflation are rare complications of the colonoscopy. Whereas the prediction of the complications might be undetectable, detection of the complications is significant as the conservative therapy is effective in the most cases as indicated in the present paper.