A case of pneumoperitoneum after diagnostic colonoscopy for ulcerative colitis managed conservatively: a rare but possible complication

Ulcerative colitis is a chronic disease characterized by recurring episodes of inflammation of the colonic mucosae. Patients with ulcerative colitis are at an increased risk of perforations due to friability of colonic mucosa. Colonoscopy is usually regarded as a safe procedure, but complications may occur. Perforations associated with colonoscopy are dreaded complications. Most patients with pneumoperitoneum require surgical intervention, with associated major postoperative morbidity and mortality. This case report describes a 30 year old female presenting with an extensive pneumoperitoneum 2 days after colonoscopy done for her complaint of melena for one week. Colonoscopy was suggestive of severe active colitis in background of chronic ulcerative colitis. Histopathological reports s/o inflammatory bowel disease ulcerative colitis likely. CT Abdomen was s/o diffuse concentric thickening of the large bowel more predominantly seen in rectosigmoid colon, ascending colon, caecum, IC junction and consistent with inflammatory bowel disease and moderate pneumoperitoneum noted. The patient remained stable despite intraperitoneal free air. Patient was managed conservatively and no surgical intervention needed.

Perforacja żołądka jako powikłanie endoskopowej cholangiopankreatografii wstecznej – opis przypadku

ABSTRACTEndoscopic retrograde cholangiapancreatography (ERCP) is an invasive diagnostic and therapeutic procedure in bile duct diseases. These procedures have severe complications, yet gastric perforation hasn’t been presented in literature.We present a case study of an 82 year old woman admitted to hospital due to suspected choledocolithiasis. The patient underwent two ERCP procedures. Due to acute abdominal pain, abdominal radiography was also performed. The examination revealed intraperitoneal free air. The patient underwent open repair of the perforated stomach. The second day after surgery the patient suffered multiorgan failure and was transmitted to the intensive care unit where she died 2 days later.

Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.