Images in Clinical Medicine
Sigmoid Perforation in Association with Colonoscopy
N Engl J Med 2012; 366:744February 23, 2012
- Article
A 74-year-old woman was undergoing a screening colonoscopy when it became apparent that the rectosigmoid junction might have become perforated. The procedure was terminated, and radiographs were obtained. The abdominal radiograph (Panel A) revealed retroperitoneal free air outlining the right kidney (white asterisk) and psoas muscles (black asterisks). The inferior edge of the liver was outlined by air (arrow), a feature consistent with intraperitoneal free air. A chest radiograph obtained with the patient in the upright position (Panel B) showed free air under the diaphragm (black arrows), right pneumothorax (white arrow), pneumomediastinum (arrowhead), and subcutaneous emphysema. In this case, a 1-cm perforation in the distal sigmoid, near the rectosigmoid junction, allowed air to track into the intraperitoneal and retroperitoneal spaces. Thus, pneumomediastinum, pneumothorax, and subcutaneous emphysema can on rare occasions occur after colonic perforation. The patient was taken to the operating room, where a successful repair of the sigmoid colon was performed. She was discharged 1 week later in good condition.
Albert Lu, M.D.
Loma Linda University, Loma Linda, CA
allu@llu.edu Paul Aronowitz, M.D.
California Pacific Medical Center, San Francisco, CA
