What's the diagnosis? By Dr. Charlie Ingram
A 57 yo female with a history of chronic abdominal pain, irritable bowel syndrome, cannabinoid hyperemesis, HTN, presents with abdominal pain. She was discharged last week after an admission for abdominal pain and has had increasing pain since that time. The pain is severe, generalized, and dull in character. She appears distressed. She has tachycardia, is afebrile with a normal blood pressure, and her abdomen is distended and tender. A CT is shown. What's the diagnosis? Scroll down for answer.
Answer: Intraperitoneal free air secondary to ruptured hollow viscus
- A life threatening emergency identified by the ED resident prior to radiologist's interpretation of the CT, emphasizing the improtance of the ED team looking at all of their ordered imaging themselves
- Treatment is immediate surgical consultation, initiation of broad-spectrum antibiotics aimed at gram-negative and anaerobic organisms, and IV fluid resuscitation
- This patient was suspected of having a colon perforation secondary to colonoscopy complication on previous admission
- Perforation after colonoscopy is rare (less than 0.5%) and can initially be asymptomatic
- This patient underwent emergent exploratory laparatomy and did well
- Jafri SM, Arora A. Silent perforation: an iatrogenic complication of colonoscopy. Surg Laparosc Endosc Percutan Tech. 2007 Oct;17(5):452-4. doi: 10.1097/SLE.0b013e3180dca5c4. PMID: 18049414.
- Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol. 1992 Dec;15(4):347-51. PMID: 1294644.
- Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013 Apr 8;173(7):551-6. doi: 10.1001/jamainternmed.2013.2908. PMID: 23478904; PMCID: PMC3987111.