Pneumomediastinum and Pneumoretroperitoneum with Perforation in the Sigmoid Colon Diverticulum after Colonoscopy: A Case Report and Literature Review

結腸鏡檢查後乙狀結腸憩室穿孔導致縱隔腔氣腫和後腹腔氣腫：個案討論及文獻回顧

Man Si Wong(黃文詩) ； Chih-Ho Hsu(許志豪) ； Li-Ming Tseng(曾立銘)

《中華民國大腸直腸外科醫學會雜誌》 33卷4期 (2022/12) Pp. 250-255

https://doi.org/10.6312/SCRSTW.202212_33(4).11125

摘要

Colonic perforations may occur after colonoscopy and are commonly associated with peritonitis and intraperitoneal free air. Besides pneumoperitoneum, subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum may be rare signs of retroperitoneal colonic perforations. This report presents the case of an 80-year-old woman who developed subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoretroperitoneum, and pneumoperitoneum after a colonoscopic examination. The patient underwent an emergency laparoscopic repair of a retroperitoneal colonic perforation in the sigmoid colon diverticulum. Consequently, she had uneventful postoperative recovery and was discharged nine days postoperatively. Pros and cons of possible treatment options for colonic perforation during colonoscopy, such as primary suture by surgeons, endoscopic clipping or conservative treatment, were also addressed in this report.

關鍵字

Colonoscopy ； Primary suture ； Endoscopic clipping ； Pneumoretroperitoneum ； Pneumomediastinum

並列摘要

結腸腸破裂是進行大腸鏡檢查時可能產生的併發症，後續可能併發腹膜炎以及在影像上發現腹腔內游離氣體。除了腹腔內游離氣體之外，皮下氣腫、縱隔腔氣腫、後腹腔氣腫這些罕見的情況也可能起因於後腹腔結腸破裂。此病例報告將討論一位80歲女性，在大腸鏡檢查後出現大量皮下氣腫、氣胸、縱隔腔氣腫、腹腔內氣腫及後腹腔內氣腫，並且進行緊急腹腔鏡乙狀結腸修補，術後第九天順利出院。在大腸鏡檢時發生結腸破裂時的處理方式，如外科手術縫合、內視鏡止血夾閉合破裂處、保守治療等方式的優缺點也在此報告內一併討論。

並列關鍵字

大腸鏡 ； 腸道修補 ； 內視鏡止血夾 ； 後腹腔內氣腫 ； 縱隔腔氣腫