Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema after Colonoscopic Polypectomy: A Case Report and Literature Review

大腸鏡息肉切除術後造成腹腔內積氣、後腹腔積氣、氣胸、氣縱膈及皮下氣腫之案例報告及文獻回顧

林恩楷(En-Kai Lin) ； 蔡祥麟(Hsiang-Lin Tsai) ； 張琮琨(Tsung-Kun Chang) ； 黃敬文(Ching-Wen Huang) ； 王照元(Jaw-Yuan Wang)

《中華民國大腸直腸外科醫學會雜誌》 33卷2期 (2022/06) Pp. 93-98

https://doi.org/10.6312/SCRSTW.202206_33(2).11025

摘要

Iatrogenic colonic perforations constitute an uncommon but potentially fatal complication of colonoscopy. Most of the perforations are intraperitoneal, but retroperitoneal perforations are relatively rare. Management strategies for iatrogenic colonic perforations could be divided into surgical and nonsurgical treatments depending on the type of injury, quality of the bowel preparation, underlying colonic pathology, size of the defect, time lapse of perforation, and clinical stability of the patient. Herein, we present a rare case of colonic perforation complicating with intraperitoneal and retroperitoneal free air. Literature review rendered such a production.

關鍵字

Colonoscopy ； Colonic perforation ； Pneumoretroperitoneum

並列摘要

醫源性結腸穿孔是大腸鏡檢查可能引起的一種少見但卻可能致命的併發症。大多數造成的穿孔位置多位於腹腔內，而後腹腔穿孔則較為少見。醫源性結腸穿孔的治療可分為手術和非手術的方式，要選擇何種治療會取決於穿孔的類型、是否有良好的腸道清潔、本身的結腸疾病、破洞的大小、穿孔後經過多久的時間才開始接受治療和患者的臨床情況是否穩定。因此，我們介紹了這個同時合併腹腔內及後腹腔穿孔並導致氣胸及氣縱膈的少見案例及其相關文獻回顧。病例報告：一名患者接受過大腸鏡息肉切除術後，感到腹脹、胸悶等不適感，且經過一段時間觀察後並無緩解，經由電腦斷層診斷疑似結腸穿孔導致的腹腔及後腹腔積氣，合併左側氣胸、氣縱膈及皮下氣腫。經轉診至本院接受後續評估及治療。經第一時間胸管放置及評估後，給予保守治療並密切觀察病人情況，因恢復良好順利出院。結論：大腸鏡造成的結腸穿孔雖然少見但卻很可能致命，僅僅根據臨床表現往往很難在第一時間診斷出來。以至於大腸鏡檢查後臨床情況惡化的患者，應高度警惕結腸穿孔的可能。影像學的檢查，尤其是電腦斷層掃描，為我們提供了極高的診斷率。而選擇以手術或非手術的方式會取決於各種因素。因此，治療方式必須針對每位患者的情況給予個別的評估，並且對採取非手術治療的患者要進行密切且多團隊的分析評估其治療效果及是否需要手術介入。

並列關鍵字

大腸鏡 ； 結腸穿孔 ； 後腹腔積氣

參考文獻

Eric M. Haas, Rodrigo Pedraza, Madhu Ragupathi, Ali Mahmood. Laparoscopic Primary Colorrhaphy for Acute Iatrogenic Perforations during Colonoscopy. Hindawi, Minimally Invasive Surgery, Volume 2013, Article ID 823506.

Araujo, A. V., Santos, C., Contente, H., & Branco, C. Air everywhere: colon perforation after colonoscopy. BMJ case reports 2017.

de'Angelis, N., Di Saverio, S., Chiara, O., Sartelli, M., Martinez-Perez, A., Patrizi, F.,... Catena, F. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World journal of emergency surgery 2018, 13, 5.

Dehal, A., & Tessier, D. J. Intraperitoneal and extraperitoneal colonic perforation following diagnostic colonoscopy. JSLS 2014, 18(1), 136-141.

Lohsiriwat, V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol 2010, 16(4), 425-430.