Kolonoskopi Sonrası İntra-Ekstraperitoneal Serbest Hava Olgusu: Cerrahi Müdahale Her Zaman Gerekli midir?
Öz
Kolonoskopi işlemine bağlı kalın bağırsak perforasyonu pnömatik veya mekanik etkiyle ya da terapotik işlemlere bağlı gelişebilmektedir. Hava insüflasyonu sonrası basınç artışına bağlı mukozada herniasyon gelişebilir. Bu durum, mukozayı belirgin perforasyon odağı olmaksızın havaya geçirgen hale getirebilir.
Rektum malign neoplazmı için 5 yıl önce ameliyat edilmiş ve radyasyon proktiti nedeni ile takipli 63 yaşındaki bayan hasta, yapılan kontrol kolonoskopi işleminden bir gün sonra gelişen, yavaş yavaş artan yüzde ve boyunda şişlik, nefes darlığı şikayetleri ile işlemden 3 gün sonra acil servise başvurdu. Yapılan tetkiklerinde kolonoskopiye bağlı pnömoperitoneum, pnömoretroperitoneum, pnömomediastinum, servikal ve fasial subkutan amfizem saptandı. Hastanın fizik muayenesinde peritonit bulguları olmaması, genel durumunun iyi ve işlemin üzerinden uzun süre geçmiş olması üzerine medikal takibine karar verildi. Hasta 2 günlük takip sonrasında sorunsuz şekilde taburcu edildi.
Kolonoskopiye bağlı intaperitoneal ya da ekstraperitoneal alanda serbest hava görülmesi hemen işlem esnasında olabileceği gibi uzun süre sonra da gelişebilmektedir. Bu hastalarda özellikle peritonit bulgusu yoksa, genel durumu iyi ise yakın gözlem altında medikal takip ile gereksiz cerrahi müdahaleler önlenebilir.
Anahtar Kelimeler
kolonoskopi pnömomediastinum pnömoperitoneum subkutan amfizem
Kaynakça
- 1. Huh JK, No HS, Lim HH et al. Subcutaneous emphysema, pneumomediastinum and pneumoperitoneum after colonoscopy. Korean J Med. 2009;77:1153-6.
- 2. Falidas E, Anyfantakis G, Vlachos K, Goudeli C, Stavros B, Villias C. Pneumoperitoneum, Retropneumoperitoneum, Pneumomediastinum, and Diffuse Subcutaneous Emphysema following Diagnostic Colonoscopy. Case Rep Surg. 2012;2012:108791.
- 3. Webb T. Pneumothorax and Pneumomediastinum During Colonoscopy. Anaesth Intensive Care. 1998 Jun;26(3):302-4.
- 4. Fazeli MS, Keramati MR, Lebaschi AH, Bashashati M. Extensive Subcutaneous Emphysema Due to Colonic Perforation Following Colonoscopy. J Coll Physicians Surg Pak. 2009 Jun;19(6):383-5.
- 5. Park NS, Choi JH, Lee DH et al. Pneumoretroperitoneum, Pneumomediastinum, Peumopericardium and Subcutaneous Emphysema after Colonoscopic Examination. Gut Liver. 2007 Jun;1(1):79-81.
- 6. Ho HC, Burchell S, Morris P, Yu M. Colon perforation, bilateral pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema complicating endoscopic polypectomy: anatomic and management considerations Am Surg. 1996 Sep;62(9):770-4.
- 7. Annaházi A, Polyák I, Nagy F, Wittmann T, Molnár T. “Ulcerative crepitus” - A case with subcutaneous emphysema and pneumomediastinum without colonic perforation or toxic megacolon in ulcerative colitis successfully treated conservatively. J Crohns Colitis. 2012 Jul;6(6):717-9.
- 8. Mastrovich JD, Peters N, Tripathi A. Acute onset of facial swelling during colonoscopy in a 50-year-old woman. Ann Allergy Asthma Immunol. 2004 Mar;92(3):307-12.
- 9. Cirt N, de Lajarte-Thirouard AS, Olivié D, Pagenault M, Bretagne JF. Subcutaneous emphysema, Pneumomediastinum, pneumoperitoneum and retropneumoperitoneum following a colonoscopy with mucosectomy. Gastroenterol Clin Biol. 2006 May;30(5):779-82.
- 10. Goerg KJ, Duber C. Retroperitoneal, mediastinal and subcutaneous emphysema with pneumothorax after colonoscopy. Dtsch Med Wochenschr. 1996 May 24;121(21):693-6.
Öz
Colonoscopy-related colonic perforation may occur through pneumatic or mechanical impact, or due to various therapeutic procedures. Mucosal herniation may also develop because of the increase in post-air insufflation pressure. This condition may render the mucosa air-permeable without a distinct focal perforation point.
A 63-year-old female patient, who had had surgery for malign rectal neoplasm five years before and followed-up for radiation proctitis, presented to the emergency department three days after she had control colonoscopy with complaints of a gradually deteriorating facial and cervical swelling along with respiratory distress that developed a day after the procedure. The results of the patient’s analyses revealed that she had colonoscopy-related pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, cervical and facial subcutaneous emphysema. Medical follow-up was planned for the patient since there were no signs of peritonitis in her physical examination, her overall condition was well, and because a long time had passed after the procedure. The patient was discharged after a two-day follow-up with no problems.
Colonoscopy-related intraperitoneal or extraperitoneal free air can both be seen immediately during the procedure and it can develop a long time after the procedure as well. Unnecessary surgical procedures can be prevented through medical follow-up under close monitoring in such patients particularly if they do not have peritonitis signs or symptoms and their overall condition is well.
Anahtar Kelimeler
colonoscopy pneumomediastinum pneumoperitoneum subcutaneous emphysema. colonoscopy, pneumomediastinum, pneumoperitoneum, subcutaneous emphysema.
Kaynakça
- 1. Huh JK, No HS, Lim HH et al. Subcutaneous emphysema, pneumomediastinum and pneumoperitoneum after colonoscopy. Korean J Med. 2009;77:1153-6.
- 2. Falidas E, Anyfantakis G, Vlachos K, Goudeli C, Stavros B, Villias C. Pneumoperitoneum, Retropneumoperitoneum, Pneumomediastinum, and Diffuse Subcutaneous Emphysema following Diagnostic Colonoscopy. Case Rep Surg. 2012;2012:108791.
- 3. Webb T. Pneumothorax and Pneumomediastinum During Colonoscopy. Anaesth Intensive Care. 1998 Jun;26(3):302-4.
- 4. Fazeli MS, Keramati MR, Lebaschi AH, Bashashati M. Extensive Subcutaneous Emphysema Due to Colonic Perforation Following Colonoscopy. J Coll Physicians Surg Pak. 2009 Jun;19(6):383-5.
- 5. Park NS, Choi JH, Lee DH et al. Pneumoretroperitoneum, Pneumomediastinum, Peumopericardium and Subcutaneous Emphysema after Colonoscopic Examination. Gut Liver. 2007 Jun;1(1):79-81.
- 6. Ho HC, Burchell S, Morris P, Yu M. Colon perforation, bilateral pneumothoraces, pneumopericardium, pneumomediastinum, and subcutaneous emphysema complicating endoscopic polypectomy: anatomic and management considerations Am Surg. 1996 Sep;62(9):770-4.
- 7. Annaházi A, Polyák I, Nagy F, Wittmann T, Molnár T. “Ulcerative crepitus” - A case with subcutaneous emphysema and pneumomediastinum without colonic perforation or toxic megacolon in ulcerative colitis successfully treated conservatively. J Crohns Colitis. 2012 Jul;6(6):717-9.
- 8. Mastrovich JD, Peters N, Tripathi A. Acute onset of facial swelling during colonoscopy in a 50-year-old woman. Ann Allergy Asthma Immunol. 2004 Mar;92(3):307-12.
- 9. Cirt N, de Lajarte-Thirouard AS, Olivié D, Pagenault M, Bretagne JF. Subcutaneous emphysema, Pneumomediastinum, pneumoperitoneum and retropneumoperitoneum following a colonoscopy with mucosectomy. Gastroenterol Clin Biol. 2006 May;30(5):779-82.
- 10. Goerg KJ, Duber C. Retroperitoneal, mediastinal and subcutaneous emphysema with pneumothorax after colonoscopy. Dtsch Med Wochenschr. 1996 May 24;121(21):693-6.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Mart 2024 |
| Gönderilme Tarihi | 3 Mayıs 2021 |
| Yayımlandığı Sayı | Yıl 2024Cilt: 63 Sayı: 1 |
