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CT scan of abdomen/pelvis with evidence of free air with free fluid adjacent to the transverse colon.
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Figure 1: CT scan of abdomen/pelvis with evidence of free air with free fluid adjacent to the transverse colon.

Mentions: Abdominal X-ray showed multiple air fluid levels. CT of the abdomen/pelvis showed evidence of free air with free fluid adjacent to the transverse colon (fig. 1). The patient was taken to the operating room and explored through a midline incision. Upon opening the peritoneum, there was evidence of bile stained fluid. It did not smell feculent. The colon was explored first from the cecum to the rectum and no perforation was found. The small bowel was then run from the ligament of Treitz to the terminal ileum. In the proximal jejunum, multiple very thin diverticuli were encountered. Some measured close to 3 cm. A very clear perforation was found in one of these diverticuli on the mesenteric side of the bowel. This segment of small bowel was resected using surgical staplers and a primary reanastomosis was successfully performed. Further exploration of the stomach, lesser sac, and duodenum revealed no evidence of perforation. The abdomen was irrigated, suctioned and closed. Dissection was performed on either side of the small bowel, between the mesentery and the small bowel. The mesenteric defect was closed with interrupted sutures. No other abnormalities were seen.

Jejunal Perforation following Screening Colonoscopy

Pasumarthy L, Srour J, Johnson D - Case Rep Gastroenterol (2008)

Bottom Line: Colonoscopy is rarely associated with complications such as colonic perforation.Perforation of the small bowel is extremely rare, especially if the procedure is done without therapeutic interventions.Several factors are associated with this entity.

Affiliation: Department of Medicine, York Hospital, York, Pa., USA.

ABSTRACT
Colonoscopy is rarely associated with complications such as colonic perforation. Perforation of the small bowel is extremely rare, especially if the procedure is done without therapeutic interventions. Several factors are associated with this entity. Perforation of the ileum has been reported, but proximal jejunal perforation secondary to rupture of jejunal diverticulum during colonoscopy has not been reported. We present the case of an 88-year-old patient who developed abdominal pain after undergoing colonoscopy without any additional interventions. Urgent exploration revealed perforation of the proximal jejunum secondary to rupture of a jejunal diverticulum. No therapy or biopsies were undertaken during the colonoscopy, which are known predisposing factors.

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