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10.5005/jp-journals-10033-1234
Scoliosis as a Rare Risk Factor for Colon Perforation during Colonoscopy: The Second Reported Case and Literature Review
caSe repOrt

Scoliosis as a Rare Risk Factor for Colon Perforation

during Colonoscopy: The Second Reported Case and
Literature Review

2
1 Sameer AlOsaimi, Shehab Ekrouf, Ahmed AlMulla
3
ABSTRACT However, this invasive procedure is performed with
Background: Colonoscopy has been accepted as the best some risk of hemorrhage, perforation and even death. 1,2
method for the screening, diagnosis, treatment and follow-up Colonoscopic perforation (CP) has become one of the
of colorectal pathologies. It is an invasive procedure with most fearsome complications of routine or therapeutic
many recognized complications such as iatrogenic colonic
perforation (CP). Knowledge of the factors influencing (CP) is gastrointestinal endoscopy. The incidence of iatrogenic
of decisive importance, especially with regard to the avoidance perforation is reported to range between 0.01 and 0.8%
or minimization of the perforations. This is the second case for diagnostic and routine colonoscopy, and from 0.15 to
in the literature with such unreported and rare risk factor for 3% for therapeutic colonoscopy, 1,3-6 with rectosigmoid as
iatrogenic colonoscopic perforation. 7-11
Case summary: We reported a 66-year-old female, not the most common site of colonic perforation.
known to have any medical problems, underwent colonoscopy Major complications such as perforation and hemorr-
screening. No abnormalities detected up to the rectosigmoid hage occur 2.4 times more often in the right than in the left
junction when the gastroenterologist noted sudden and colon during therapeutic endoscopy. Knowing risk fac-
12
massive abdominal distension, the patient started com -
plaining of severe generalized abdominal pain, however, she tors, recognizing early signs of perforations, and giving
was hemodynamically stable. The procedure abandoned. early and optimal treatment may reduce the probability
11
Abdominal X-ray showed severe scoliotic deformity of the of complications and death.
lumber spine with massive pneumoperitoneum. Diagnostic We are describing an iatrogenic CP where the mecha-
laparoscopy showed a small perforation at the anterior wall of
sigmoid colon which was repaired, no fecal soiling of the peri- nism of CP is related to patient’s skeletal deformity that
toneal cavity was found as she was prepared for colonoscopy. precipitated the injury, the CP managed surgically. The
Her course was unremarkable, and she was discharged 7 days first case with such injury was described in 2010, and
13
later. A 2-week follow-up showed her to be asymptomatic with 14
healed laparoscopic surgery scars and normal bowel motion. still in publishing process. This is the second case in
Conclusion: Patients with skeletal deformity such as scoli o- the literature with such unreported and rare risk factor
sis undergoing colonoscopy have a higher risk of iatrogenic for iatrogenic colonoscopic perforation.
colonoscopic perforation. Symptoms of abdominal pain and
distension during colonoscopy in this group of patients should CASE REPORT
alert the treating doctor for the possibility of colon injury which
should be managed accordingly. We reported a 66-year-old female, not known to have any
Keywords: Colon perforation, Iatrogenic perforation, Scoliosis, medical problems, underwent colonoscopy screening. No
Skeletal deformity, Colonoscopy. abnormalities detected up to the rectosigmoid junction
How to cite this article: AlOsaimi S, Ekrouf S, AlMulla A. when the gastroenterologist noted sudden and massive
Scoliosis as a Rare Risk Factor for Colon Perforation during abdominal distension, the patient started complaining
Colonoscopy: The Second Reported Case and Literature
Review. World J Lap Surg 2014;7(3):133-135. of severe generalized abdominal pain, however, she
Source of support: Nil was hemodynamically stable. The procedure was aban-
doned and was taken immediately to resuscitation room,
Conflict of interest: None
abdo minal examination showed peritonitis. Chest X-ray
inTROduCTiOn revealed air under the diaphragm (Fig. 1). Abdominal
X-ray showed severe scoliotic deformity of the lumber spine
Colonoscopy is a common procedure for the diagno-
sis, treatment and follow-up of colorectal pathologies. with massive pneumoperitoneum (Fig. 2). Diagnostic
laparoscopy showed a small perforation of 1.0 cm at the
anterior wall of sigmoid colon which was repaired lapa-
roscopically, no fecal soiling of the peritoneal cavity was
1 Department of Surgery, Al-Sabah Hospital, Kuwait City, Kuwait
found as she was prepared for colonoscopy. She was
2,3 Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait covered with anti biotics postoperatively. Her course was un-
Corresponding Author: Sameer AlOsaimi, Department remarkable, and she was discharged 7 days later. A 2-weeks
of Surgery, Al-Sabah Hospital, Kuwait City, Kuwait, Phone: follow-up showed her to be asymptomatic with healed
0096599302600, e-mail: Hudood2004@yahoo.com
laparoscopic surgery scars and normal bowel motion.
World Journal of Laparoscopic Surgery, September-December 2014;7(3):133-135 133