Colonic perforation following endoscopy revealed by plain radiography

A 77-year-aged male patient without a remarkable medical history underwent colonoscopy because of chronic constipation and colon cancer family history. Colonoscopy failed at the 50 cm from the anal verge by the presence of bleeding from the proximal site of the colon. While retracting endoscope adipose tissue of retroperitoneum appeared. The lumen of the colon was collapsed (blue arrow) and immediately procedure was terminated (Fig. 1A). Patient did not complain of abdominal pain. The conventional X-ray of the abdomen and the chest was obtained. The abdominal X-ray revealed retroperitoneal and subdiaphragmatic free air. Chest X-ray (Fig. 1B) revealed bilateral subdiaphragmatic free air (yellow arrows). Patient was referred to Osmangazi University Hospital General Surgery Department and primary repair of a sigmoid colonic perforation was successfully performed. Postoperative course was uneventful and he was discharged 10 days later. A carefully observation while retracting endoscope can be useful to diagnose a potential injury of colon. Conventional X-ray is a simple and fast diagnostic method for gastrointestinal perforations [1]. Patients over 75 years of age have a higher risk of perforation during colonoscopy [2]. Immediate diagnosis gave a chance of a primary closure of perforation and refrain from peritonitis. Earlier a primary closure of perforation has a low rate of leakage rate [3]. Figure 1: (A) Colonoscopic image of perforation (B) Convential X-ray revealed bilateral subdiaphragmatic free air.