The patient just had a colonoscopy and multiple biopsies taken for the polyps at descending colon. Persistent abdominal discomfort and distension raise high suspicion of perforation as a complication of post-colonoscopy. This is proven with erect chest radiograph, CT scan as well as during exploratory laparotomy. Intraoperatively, extensive pneumoperitoneum but unable to detect obvious colonic perforation, suspicious of micro-perforation.

Bowel perforation is known complications post-optical colonoscopy.