The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction
Colonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and s...
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doaj-bf745f6780f948f9baf99addf34493d92020-11-24T23:29:21ZengHindawi LimitedCase Reports in Surgery2090-69002090-69192018-01-01201810.1155/2018/80201978020197The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial InfarctionMaria Francesca Secchi0Carlo Torre1Giovanni Dui2Francesco Virdis3Mauro Podda4Department of Emergency and Acute Care Medicine, San Francesco Hospital, Nuoro, ItalyDepartment of Gastrointestinal Endoscopy, San Francesco Hospital, Nuoro, ItalyDepartment of Radiology, San Francesco Hospital, Nuoro, ItalyDepartment of Trauma and Emergency Surgery, King's College Hospital, London, UKDepartment of General, Emergency, and Robotic Surgery, San Francesco Hospital, Nuoro, ItalyColonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and symptoms may develop. The aim of this report is to raise the awareness on the likelihood of rare clinical features of colonoscopic perforation. A 72-year-old male patient with a past medical history of myocardial infarction presented to the emergency department four hours after a screening colonoscopy with polypectomy, complaining of neck pain, retrosternal oppressive chest pain, dyspnea, and rhinolalia. Right chest wall and cervical subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and bilateral subdiaphragmatic free air were reported on the chest and abdominal X-rays. The patient was treated conservatively, with absolute bowel rest, total parental nutrition, and broad-spectrum intravenous antibiotics. Awareness of the potentially unusual clinical manifestations of retroperitoneal perforation following colonoscopy is crucial for the correct diagnosis and prompt management of colonoscopic perforation. Conservative treatment may be appropriate in patients with a properly prepared bowel, hemodynamic stability, and no evidence of peritonitis. Surgical treatment should be considered when abdominal or chest pain worsens, and when a systemic inflammatory response arises during the conservative treatment period.http://dx.doi.org/10.1155/2018/8020197 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Maria Francesca Secchi Carlo Torre Giovanni Dui Francesco Virdis Mauro Podda |
spellingShingle |
Maria Francesca Secchi Carlo Torre Giovanni Dui Francesco Virdis Mauro Podda The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction Case Reports in Surgery |
author_facet |
Maria Francesca Secchi Carlo Torre Giovanni Dui Francesco Virdis Mauro Podda |
author_sort |
Maria Francesca Secchi |
title |
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction |
title_short |
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction |
title_full |
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction |
title_fullStr |
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction |
title_full_unstemmed |
The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction |
title_sort |
close relationship between large bowel and heart: when a colonic perforation mimics an acute myocardial infarction |
publisher |
Hindawi Limited |
series |
Case Reports in Surgery |
issn |
2090-6900 2090-6919 |
publishDate |
2018-01-01 |
description |
Colonoscopic perforation is a serious and potentially life-threatening complication of colonoscopy. Its incidence varies in frequency from 0.016% to 0.21% for diagnostic procedures, but may be seen in up to 5% of therapeutic colonoscopies. In case of extraperitoneal perforation, atypical signs and symptoms may develop. The aim of this report is to raise the awareness on the likelihood of rare clinical features of colonoscopic perforation. A 72-year-old male patient with a past medical history of myocardial infarction presented to the emergency department four hours after a screening colonoscopy with polypectomy, complaining of neck pain, retrosternal oppressive chest pain, dyspnea, and rhinolalia. Right chest wall and cervical subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and bilateral subdiaphragmatic free air were reported on the chest and abdominal X-rays. The patient was treated conservatively, with absolute bowel rest, total parental nutrition, and broad-spectrum intravenous antibiotics. Awareness of the potentially unusual clinical manifestations of retroperitoneal perforation following colonoscopy is crucial for the correct diagnosis and prompt management of colonoscopic perforation. Conservative treatment may be appropriate in patients with a properly prepared bowel, hemodynamic stability, and no evidence of peritonitis. Surgical treatment should be considered when abdominal or chest pain worsens, and when a systemic inflammatory response arises during the conservative treatment period. |
url |
http://dx.doi.org/10.1155/2018/8020197 |
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