T KARŞIDAĞ, J. A ASENSİO, S TÜZÜN, A. KOCAKUŞAK

Pneumopericardium, pneumomediastinum, pneumoretroperitoneum, pneumoscrotum after diverticular perforation developed during colonoscopy

Fleksibl sigmoidoskopi işlemi esnasında kolon perforasyonu gelişme insidansı %0.1, tanısal amaçlı yapılan kolonoskopide %0,16 ve tedavi amaçlı yapılan kolonoskopide %0.44’dür. Kolonik perforasyon retroperitoneal alanda hava birikimine neden olur. Bu çok ender görülen bir durumdur. Burada sunulan olgu 73 yaşında erkek hasta, diagnostik kolonoskopi sonrasında boynunda şişme, orta düzeyli karın ağrısı ve batın distansiyonu ile görüldü. Akciğer ve ayakta direkt batın grafisi ile birlikte batın tomografisinde subkutan anfizem, retroperitoneal hava, pnömoperikardium, pnömomediastinum ve pnömoskrotum izlendi. Burada kolon perforasyonlu bir hastada, havanın retroperitoneal alandan intraperikardial alana ve skrotuma yayılma yolu vurgulandı.

Kolonoskopi sırasında gelişen divertiküler perforasyon sonrası pnömoperikardiyum, pnömomediastinum, pnömoretroperitoneum ve pnömoskrotum

The incidence of colon perforation is 0.1 percent for flexible sigmoidoscopy, 0.16 percent for diagnostic colonoscopy, and 0.44 percent for colonoscopy plus therapeutic intervention. Colonic perforation can lead to air accumulation in the retroperitoneal space and in a variety of places. This is a very rare entity. We report a case of a 73-year-old man investigated for enlargement of the neck, mild abdominal pain and distention after a diagnostic colonoscopic procedure. A chest and abdominal X-ray with CT scan showed subcutaneous emphysema, retroperitoneal air, pneumopericardium, pneumomediastinum, and pneumoscrotum. This report pointed out the pathway of the air from the retroperitoneal space to the intrapericardial space and into the scrotum in a patient with a colon perforation.

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1. Bakker J, van Kersen F, Bellaar Spruyt J. Pneumopericardium and pneumomediastinum after olypectomy. Endoscopy 1991;23(1):46-7.
2. Mirzayan R, Cepkinian V, Asensio JA. Subcutaneous emphysema, pneumomediastinum, pneumothorax, pneumopericardium and pneumoperitoneum from rectal barotrauma. J Trauma 1996;41(6):1073‐5.
3. Fitzgerald SD, Denk A, Flynn M, et al. Pneumopericardium and subcutaneous emphysema of the neck: An unusual manifestation of colonoscopic perforation. Surg Endosc 1992;6(2):141‐3.
4. Schmidt GB, Bronkhorst MW, Hartgrink HH, et al. Subcutaneous cervical emphysema and pneumomediastinum due to a lower gastrointestinal tract perforation. World J Gastroenterol 2008;14(24):3922‐3.
5. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema, pathophysiology, diagnosis and management. Arch Intern Med 1984;144:1447-53.
6. Fledman MG, Lustberg H. Pneumomediastinum: Retroperitoneal pathway. Conn Med 1999;63(3):579-82.
7. Chalumeau M, Le Clainche L, Sayeg N, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001;31(1):67- 75.
8. Schoenamann J. Pneumoperikard sowie retroperitoneales und skrotalemphysem nach endoskopischer Papillotomie. Z Gastroenterol 2000;38(1):45‐7.
9. Webb T. Pneumothorax and pneumomediastinum during colonoscopy. Anaesth Intens Care 1998;26(2):302-4.
10. Amshel AL, Shonberg IL, Gopal KA. Retroperitoneal and mediastinal emphysema as a complication of colonoscopy. Dis Colon Rectum 1982;25(1):167-8.