Colonic perforation is a well-known, leading complication of colonoscopy. The incidence
of colonic perforation ranges from 0.03 % to 0.65 % in diagnostic colonoscopies and
from 0.07 % to 2.14 % in therapeutic colonoscopies [1]
[2].
A 66-year-old woman was admitted for left colonic stricture. This patient had been
treated for colonic perforation almost 1 year previously. At that time, she had been
undergoing investigation by the gastroenterology department because of intermittent
diarrhea. Colonoscopy was otherwise unremarkable with completely normal colorectal
findings. The patient developed abdominal pain, nausea, and slight abdominal distension
a few hours after colonoscopy. Plain abdominal radiography showed free air under the
right diaphragm. Nasogastric decompression, intravenous fluids, and antibiotic treatment
were immediately started. The physical examination findings improved gradually. The
nasogastric tube was removed on day 5. A computed tomography scan was performed, which
showed a normal abdominal image, and the patient was discharged on day 12.
Upon her second admission 9 months later, the patient declared that her bowel habits
had gradually changed during the past 3 months. Colonoscopy was intended, but the
colonoscopy could not pass through a stricture found on the sigmoid-left colon region.
Barium enema confirmed the stricture on the sigmoid junction with inadequate passage
of the contrast to the proximal segments ([Fig. 1 a]). The length of the stricture segment was 2–3 cm. We considered performing a balloon
dilatation of the short stricture; however, the patient’s family did not consent to
this treatment. Laparotomy was performed for the symptomatic colonic stricture of
unknown nature. A thin, benign-looking stricture that resembled an anastomotic stenosis
was found on the very proximal sigmoid colon ([Fig. 1 b – d]. The stricture was not uniformly circumferential. Histopathology revealed only fibrotic
changes with no additional abnormalities in or around the narrowed region.
Fig. 1 a The stricture on the sigmoid junction with inadequate passage of the contrast to
the proximal segments (arrow). b, c, d Intraoperative view: a thin benign-looking stricture that resembled an anastomotic
stenosis was found on the very proximal sigmoid colon (arrow).
This report describes a late complication of a colonic perforation. Such an occurrence
is added to the rare and interesting complications of colonoscopy, such as splenic
rupture [3] or transverse mesocolon laceration [4].
Endoscopy_UCTN_Code_CPL_1AJ_2AB
