We wish to report a rare complication of colonoscopy with
incarceration of the colonoscope in an inguinal hernia.
An 81-year-old man underwent colonoscopy for routine surveillance.
He had a rather large left inguinal hernia that was not reducible. However, he
had not presented for this disease before colonoscopy. After he was consciously
sedated with pethidine hydrochloride, the procedure was performed without
difficulty until the cecum was reached at approximately 120 cm. As the
colonoscope was withdrawn, the colon was observed. However, at approximately
60 cm the colonoscope could not be withdrawn further although the lumen
was clearly visible. Thus, the colonoscope appeared to be inexplicably frozen
in position. On examining the left inguinal hernia, it became clear that the
colonoscope had become incarcerated within the hernia sac and could not be
withdrawn even with gentle external traction. The patient was taken immediately
to the X-ray room, where the colonoscope together with a part of the small
intestine was shown, as expected, to be within the hernia sac ([Fig. 1]).
Fig. 1 Colonoscope with a part
of the small intestine found within the hernia sac.
Under radiographic guidance, the colonoscope was slowly and
carefully withdrawn by gentle traction without incident. The procedure was
terminated, and the patient was referred to the surgery department for
consideration for hernia repair.
There have been two reports of restoration of this complication,
with radiographic guidance [1] or by external manual
pressure [2]. The presence of an inguinal hernia is not a
contraindication to colonoscopy. However, a careful history and physical
examination before colonoscopy are important because they can put the
endoscopist on the alert for a potential hazard such as the one we
encountered.
Endoscopy_UCTN_Code_CPL_1AJ_2AB
