Clinical Review Lesson of the week

A life threatening complication after colonoscopy

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7496.889 (Published 14 April 2005) Cite this as: BMJ 2005;330:889
  1. Simon E J Janes, surgical house surgeon ([email protected])1,
  2. Ian A Cowan, consultant radiologist2,
  3. Birgit Dijkstra, consultant surgeon1
  1. 1 Department of General Surgery, Christchurch Public Hospital, Private Bag 4710, Christchurch, New Zealand,
  2. 2 Department of Radiology, Christchurch Public Hospital
  1. Correspondence to: Dr S E J Janes, Department of Surgery, New Cross Hospital, Wolverhampton WV10 0QP
  • Accepted 3 March 2005

Introduction

Colonoscopy is a widely used diagnostic and therapeutic intervention. The procedure is usually well tolerated, with less than 0.5% of patients developing bowel perforation. Perforation usually manifests soon after the procedure with generalised abdominal pain. We present the case of a near fatal complication after colonoscopy in which the initial features suggested bowel perforation but further investigation showed an unsuspected cause that necessitated urgent surgery.

Computed tomogram showing intrasplenic haematoma (A), extravasating contrast indicating active bleeding (B), and haemoperitoneum (C)

Case report

A 47 year old woman presented to our emergency department 24 hours after colonoscopy with left shoulder tip and abdominal pain. Her abdominal pain felt like “trapped wind,” becoming progressively worse throughout the day. Two weeks previously, she had had hysteroscopy and laparoscopy to investigate menorrhagia and had been diagnosed with endometriosis. Colonoscopy was performed to exclude colonic involvement. She had been given 5 mg intravenous diazepam for sedation, and colonoscopic diathermy or biopsy had not been used. She had insulin dependent type 2 diabetes, with hypertension and hyperlipidaemia.

On examination she was pale, but vital signs were normal. Her lower abdomen was tender, with normal bowel sounds and no abdominal distension. Initial blood tests showed a haemoglobin concentration of 76 g/l …

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