Subserosal bowel perforation during colonoscopy for Crohn’s disease - 16/08/11
Doi : 10.1016/j.gie.2006.04.003
| Commentary It is not routine to perform imaging studies after most endoscopic procedures and for good reason. The sensitive tests we do today will likely yield findings of little clinical consequence that may serve to fuel the appetite of our already-ravenous medicolegal system. This case is perhaps such an example, but it does teach us a few things: (1) postprocedural gas in the portal and mesenteric veins and in the retroperitoneum does not have the same poor prognosis as when resulting from bowel necrosis; (2) in this case, it is likely that a closed-loop phenomenon, with resultant higher-than-usual intraluminal pressures, was engendered by the ileocecal stricturing proximally and the presence of the scope in the anal canal, thus facilitating gas dissection; (3) it is curious, however, that such extraintestinal air occurs so rarely in Crohn’s disease where, as the investigators point out, fissuring might facilitate it. It would be curious to see how often such gas is demonstrated in various diseases, but one must be careful not to be hoisted on one’s own petard. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2006
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 64 - N° 5
P. 818-819 - novembre 2006 Ritorno al numero
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