Iatrogenic perforation of the colon following retroflexion maneuver

Abstract

A 76-year-old man visited our hospital because he had tested positive for fecal occult blood. A colonoscope was easily introduced into end of the ileum without pain or distension. A pedunculated polyp was detected in the ascending colon near the hepatic flexure ([Figure 1]). The patient felt no abdominal pain or distension during electrocauterization polypectomy. Arterial bleeding occurred immediately after polypectomy, so, as the location of the bleeding point was difficult to access in the forward view, the scope was retroflexed in the ascending colon to allow placement of hemoclips. Subsequently, the patient complained of pain and developed pneumoperitoneum. Emergency computed tomography (CT) showed a large amount of free air, especially in the left retroperitoneal space ([Figure 2]). Surgery revealed a transmural laceration at the transverse colon near the splenic flexure, and not at the polypectomy site. The patient recovered uneventfully after laparotomy.