Actual Colonic Perforation in Virtual Colonoscopy: Report of a Case

Abstract

Computed tomography colonography, also termed virtual colonoscopy, is a new imaging method to investigate the colon, which may be a potential alternative to the conventional endoscopic colonoscopy in some cases. The high safety profile of this imaging method was considered as an additional advantage of this procedure. A case of colonic perforation in computed tomography colonography is presented, highlighting a potential risk related to this procedure. It is assumed that perforation was the result of overinflation of air into an obstructed colon caused by a lesion at the rectosigmoid junction. Thus, it is suggested that in such cases, air insufflation should be gradual, thereby minimizing the risk of perforation.

Risk Factors for Colonic Perforation after Screening Computed Tomographic Colonography: A Multicentre Analysis and Review of the Literature

“…The insufflation technique is also important. The use of manual insufflation (rather than with an automatic insufflator) can increase colonic distension, with its associated increased risk of perforation, 6,7,10,11,14,15,17,18,20 and similarly an increased total volume of gas insufflated can potentiate perforation, whether this is due to too high an insufflation rate (higher than 2 L/minute) or for too long a period of time. 12 Ten metropolitan tertiary referral centres throughout the state of Victoria, Australia were reviewed for the number of cases of CT colonography performed in the preceding five-year period, with a total of 3458 such procedures undertaken.…”

“…Both patients were elderly and had undergone recent colonoscopy. Notably, one patient had diverticular disease, and one had recent colonic biopsy, both Hernia (inguinal or other involving large bowel) 8 -11 Connective tissue disorder/corticosteroid use 7 Recent colonoscopy 5,8 Recent colonic biopsy (+length of time since) 8,10,11,14 Previous colorectal surgery 6 Diverticular disease 5,10 -13 Active colon cancer 5,9 -11,14,15 Current or previous large bowel obstruction 8,16 -19 Other colonic disorder 7,8,10,11,18,20 Procedural factors Reduced institutional experience with colonography (number of cases) 6,10,11,21,22 Insufficient lubrication of rectal tube 8 Use of a rectal balloon 9 -11 Distention technique: manual (versus automatic) insufflation 6,7,10,11,14,15,17,18,20 Volume of insufflation (incorporating the rate and/or duration of insufflation)…”

Colonoscopy vs CT colonography to screen for colorectal neoplasia in average-risk patients

“…Electrocautery injury during biopsy and mechanical injury caused by penetration of the endoscopeÕs tip and shaft are the most common complications. To my knowledge, there is only one reported case of perforation from a CTC [46], and this was in a patient with a distal obstructing rectosigmoid cancer. Although to date far fewer CTC exams than colonoscopies have been performed world wide, it is likely that the risk of perforation from CTC in a screening population will ultimately prove to be even lower than the very minimal risk of perforation from colonoscopy.…”

Virtual colonoscopy-induced perforation in a patient with Crohn’s disease

“…This may have accounted for the close proximity between the perforation site and stricture in our patient. There are case reports of colonic perforations in patients with ulcerative colitis [4] or carcinoma of the colon [5] .…”