Case ReportBilateral tension pneumothorax during colonoscopy in a patient with chronic obstructive pulmonary disease: a case report☆,☆☆
Introduction
Minor complications from colonoscopy including abdominal pain, bloating, self-limited gastrointestinal bleeding, diarrhea, and nausea occur in up to 33% of cases. Reported symptoms were generally mild and resolved within 2 days after the procedure [1], [2], [3]. However, a systematic review reported an overall incidence rate of 0.28% for severe complications including cardiopulmonary, perforation, hemorrhage, infection, and other miscellaneous complications (ie, splenic rupture, diverticulitis, and subcutaneous emphysema) [1], [2] during screening colonoscopy [1], [2], [4]. In addition, life-threatening complications, such as gas explosion leading to tension pneumoperitoneum [5] and colonoscopy-related mortality [1], [2], [6], were also reported. To our best knowledge, tension pneumothorax resulted from the Valsalva maneuver due to intractable pain during colonoscopy has rarely been reported.
Section snippets
Case report
A 95-year-old man (height, 170 cm; weight, 82 kg; body mass index, 28.4 kg/m2), who was classified as American Society of Anesthesiology physical status III due to a medical history of hypertension and chronic obstructive pulmonary disease and maintained on regular medication and follow-up, approached our emergency department for abdominal pain of 3 days. He was diagnosed with sigmoid volvulus based on the results of the plain abdominal radiography (Fig. 1). Plain chest radiography was also
Discussion
Colonoscopy is currently the most widely used diagnostic and therapeutic procedure in gastroenterology. Despite the low incidence rate of complications, which are mostly mild and present with less serious symptoms, the potentially life-threatening complications of colonoscopy still exist albeit rarely.
Tension pneumothorax during or after colonoscopy has been previously reported [7], [8], [9], [10]. In these case reports, the etiology was usually iatrogenic colonic perforation due to barotrauma
Conclusion
Although tension pneumothorax rarely develops during colonoscopy, this case report emphasizes that practitioners should be aware of the possibility of pulmonary complications, especially in patients with preexisting pulmonary comorbidities. These patients should be informed of the risk of possible complications, including colonic perforation, pneumothorax, pneumoperitoneum, and pneumomediastinum (ie, the so-called triple pneumo). Adequate analgesia and sedation, which are administered to
Author's contributions
Wei-Cheng Tseng, Chun-Chang Yeh, Zhi-Fu Wu, and Shinn-Long Lin contributed to writing the manuscript. Shu-Wen Jao contributed to clinical care. All authors read and approved the final manuscript.
Acknowledgments
None.
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