Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation

대장내시경 천공에 의한 기흉, 종격동기종, 피하공기증, 공기후복막증

  • Yim, Ju-Kyeon (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Kim, Yeong-Muk (Department of Internal Medicine, Wallace Memorial Baptist Hospital) ;
  • Park, Sung-Nam (Department of Internal Medicine, Wallace Memorial Baptist Hospital)
  • 임주견 (왈레스기념 침례병원 내과) ;
  • 김영묵 (왈레스기념 침례병원 내과) ;
  • 박성남 (왈레스기념 침례병원 내과)
  • Published : 2011.01.30
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Abstract

A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping.

대장내시경 검사에 의한 천공은 드물게 발생하며 직장에서의 천공은 후굴 시 발생할 수 있다. 천공의 양상은 복막내 혹은 복막뒤공간으로도 발생하며 천공 시 유출된 복막뒤공간의 공기는 내장 공간을 통해 이동하여 종격동기종, 피하공기증, 기흉 등을 유발할 수 있다. 따라서 천공 후 복부 증상 없이 피하공기증, 호흡곤란, 흉통을 호소하는 경우 진단이 지연될 수 있어 주의가 필요하다. 내시경 검사 중 발생한 대장 천공은 수술치료를 해야 하는 경우가 많지만 일부 환자에서는 보존 치료를 할 수 있으며 특히, 복막뒤공간으로의 천공과 복막반전 아래부분의 직장 천공은 보존 치료로 회복될 가능성이 상대적으로 더 높다. 최근에는 클립 봉합술이 성공적으로 시행되어 치료에 많은 도움을 주고 있다. 저자들은 대장내시경 중 직장에서 후 굴에 의해 발생한 천공이 복부 증상이 동반되지 않은 기흉, 종격동기종, 피하공기증으로 나타나 지연 진단되었던 증례를 경험하여 문헌고찰과 함께 보고한다.

Keywords

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