Explosive colonic perforation, a catastrophic complication of rectal Argon Plasma Coagulation therapy

Abstract Argon plasma coagulation (APC) is a widely used technique which uses a jet of ionised argon gas to help control gastrointestinal bleeding. A 65-year-old gentleman underwent APC for radiation induced proctitis. On ignition of the argon laser, a large “popping” noise was heard and he experienced immediate abdominal pain. He had suffered a large sigmoid perforation that required a Hartmann’s procedure. Spontaneous colonic explosion is a known, but very rare, complication of APC. It has been suggested this is due to high intraluminal levels of combustible gases such as hydrogen or methane. Levels of these are thought to be reduced by full bowel preparation. Oxygen is also required for combustion, levels of which can be reduced by using carbon dioxide as the insufflated gas during the colonoscopy, rather than room air. Use of both full bowel preparation and C0 2 insufflation could help prevent this rare complication from occurring in the future.