Pneumoperitoneum - iatrogenic

Case contributed by Dr Yair Glick

Presentation

Sigmoid colon perforation 30 cm from anal verge at elective colonoscopy. Asymptomatic.

Patient Data

Age: 70 years
Gender: Male
X-ray

Scout view

Scout view: Large amount of pneumoperitoneum, roughly oval in shape, with outlined falciform ligament - football sign. Lucent right paravertebral streak from L1/L2 to S1 - pneumoretroperitoneum? Streaks of gas in pelvis. Surgical clips projected on sigmoid colon.

CT

Massive pneumoperitoneum. Moderate amount of pneumoretroperitoneum on right.
Diverticulosis of the sigmoid and descending colon. Surgical clips in the mid-sigmoid colon.
Sternotomy closure wire noticed.
 

Case Discussion

A patient with left-sided colonic diverticulosis was referred to CT abdomen for assessment of intra-abdominal free air following accidental perforation of his sigmoid colon at colonoscopy.

The football sign is clearly seen on the scout view.

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Case information

rID: 63103
Published: 14th Sep 2018
Last edited: 14th Sep 2018
Inclusion in quiz mode: Included

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