Colonoscopy Results in Severe Intestinal Perforation

Generally, a colonoscopy is a safe procedure and complications are rare. Such complications may include colonic perforation, bleeding, infection, abdominal distention, postpolypectomy coagulation syndrome, splenic rupture, small bowel obstruction, and medication effects. Mechanical perforation by the tip of the instrument occurs at sites of weakness of the colon wall (diverticula, transmural inflammation) and proximal to obstructing points (neoplasms, strictures). Pneumatic perforation of the colon or ileum results from distention by insufflated air. It should be able to be detected quite rapidly as fever and leukocytosis may eventually develop with any of these perforations. When plain abdominal or chest radiographs show pneumoperitoneum, gross extravasation should be assessed, and, if present, surgical intervention is required. In the absence of leakage, treatment with intravenous antibiotics and close observation may be considered. This would be a clinical determination.