Clinical Endoscopy

  • 제42권1호
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  • Pages.38-42
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  • 2011
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

대장내시경 천공에 의한 기흉, 종격동기종, 피하공기증, 공기후복막증

Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation

  • 임주견 (왈레스기념 침례병원 내과) ;
  • 김영묵 (왈레스기념 침례병원 내과) ;
  • 박성남 (왈레스기념 침례병원 내과)
  • 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)
  • 발행 : 2011.01.30
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

  1. Marwan K, Farmer KC, Varley C, Chapple KS. Pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema following diagnostic colonoscopy. Ann R Coll Surg Engl 2007;89:W20-21.
  2. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management. Arch Intern Med 1984;144:1447-1453. https://doi.org/10.1001/archinte.1984.00350190143024
  3. Fitzgerald SD, Denk A, Flynn M, Longo WE, Vernava AM 3rd. Pneumopericardium and subcutaneous emphysema of the neck. An unusual manifestation of colonoscopic perforation. Surg Endosc 1992;6:141-143. https://doi.org/10.1007/BF02309088
  4. Petros JG, Thanikachalam M, Lopez MJ. Retroperitoneal and abdominal wall emphysema after transanal excision of a rectal carcinoma. Am Surg 1996;62:759-761.
  5. Wullstein C, Koppen M, Gross E. Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc 1999;13:484-487. https://doi.org/10.1007/s004649901018
  6. Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007;21:994-997. https://doi.org/10.1007/s00464-007-9251-7
  7. Quallick MR, Brown WR. Rectal perforation during colonoscopic retroflexion: a large, prospective experience in an academic center. Gastrointest Endosc 2009;69:960-963. https://doi.org/10.1016/j.gie.2008.11.011
  8. Macia I, Moya J, Ramos R, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007;31:1110-1114. https://doi.org/10.1016/j.ejcts.2007.03.008
  9. Zeno BR, Sahn SA. Colonoscopy-associated pneumothorax: a case of tension pneumothorax and review of the literature. Am J Med Sci 2006;332:153-155. https://doi.org/10.1097/00000441-200609000-00012
  10. Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC. Clinical presentation and management of iatrogenic colon perforations. Am J Surg 1996;172:454-457. https://doi.org/10.1016/S0002-9610(96)00236-X
  11. Iqbal CW, Chun YS, Farley DR. Colonoscopic perforations: a retrospective review. J Gastrointest Surg 2005;9:1229-1235. https://doi.org/10.1016/j.gassur.2005.06.023
  12. Farley DR, Bannon MP, Zietlow SP, Pemberton JH, Ilstrup DM, Larson DR. Management of colonoscopic perforations. Mayo Clin Proc 1997;72:729-733. https://doi.org/10.1016/S0025-6196(11)63592-1
  13. Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 2009;41:941-951. https://doi.org/10.1055/s-0029-1215179
  14. Kang HY, Kang HW, Kim SG, et al. Incidence and management of colonoscopic perforation in Korea. Digestion 2008;78:218-223. https://doi.org/10.1159/000190811
  15. Cho YK, Nam SW, Kim HC, et al. Conservative treatment of colonoscopic perforations. Korean J Gastrointest Endosc 2006;32:20-25.
  16. Park HJ, Eun SH, Jung HK, et al. A case of successful endoscopic therapy in delayed diagnosed perforation after endoscopic colon polypectomy. Korean J Gastrointest Endosc 2001;23:240-244.