Pneumoperitoneum after Colonoscopic Polipectomy. A Therapeutic Dilemma

Óscar Cano-Valderrama, Carlos Ferrigni, Iris Sánchez-Egido, Susana Martín-Garre, María Jesús Pérez-Contín, Manuel Giner


Backgound Pneumoperitoneum may occur following colonoscopy that may be accompanied by perforation of the colon. Most of these cases are managed by emergency surgery. However, this attitude may result in an unnecessary surgery. Cases report Two demonstrative cases of post-colonoscopy pneumoperitoneum are reported. In both cases the pneumoperitoneum appeared a few hours after uncomplicated colonoscopy plus polipectomy without clinical or laboratory evidence of peritonitis. In the first case, since perforation was suspected, a laparotomy was performed that turned out to be an unnecessary procedure. Moreover, pneumoperitoneum recurred and was satisfactorily treated by paracentesis. In our second case, conservative management under close observation was chosen and the patient made an uncomplicated recovery. Conclusion Our experience, which coincides with others’, suggests that in absence of peritoneal irritation, a conservative management should be chosen. However, if the patient deteriorates with conservative management, one should proceed to surgery.

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