Úvod: Cílem sdělení je referovat o neobvyklém výskytu symptomů při komplikaci terapeutické koloskopie. Kazuistika: 70letá polymorbidní pacientka v chronickém dialyzačním programu podstoupila ošetření sáknoucích angiektázií v céku a colon ascendens argon plazma koagulací. Krátce po výkonu se u ní objevila dušnost a podkožní emfyzém na krku, který byl mylně hodnocen jako otok. Dalším vyšetřením bylo zjištěno pneumoperitoneum, podkožní emfyzém a pneumomediastinum. S ohledem na rizikovost nemocné (komorbidity, obezita) byla indikována laparoskopie, při které nebyla nalezena perforace střevní ani peritonitis. Při další komplexní léčbě se pacientka zahojila bez dalších komplikací. Závěr: Dušnost a podkožní emfyzém nejsou typickými prvními příznaky koloskopické perforace. Náš případ potvrzuje, že na tuto komplikaci je potřeba především myslet a při podezření na ni rychle zahájit diagnostický a léčebný proces.

Introduction: The paper presents unusual symptoms as a complication of therapeutic colonoscopy. Case report: A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment. Conclusion: Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.

• MeSH
• Argon Plasma Coagulation * adverse effects   MeSH
• Blood Vessels diagnostic imaging   pathology   MeSH
• Dilatation, Pathologic surgery   diagnostic imaging   therapy   MeSH
• Iatrogenic Disease MeSH
• Colonoscopy adverse effects   MeSH
• Humans MeSH
• Mediastinal Emphysema diagnostic imaging   etiology   MeSH
• Intestinal Perforation etiology   therapy   MeSH
• Pneumoperitoneum * surgery   diagnostic imaging   etiology   MeSH
• Tomography, X-Ray Computed MeSH
• Aged MeSH
• Subcutaneous Emphysema diagnostic imaging   etiology   MeSH
• Intestine, Large surgery   diagnostic imaging   pathology   MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

74 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation program, on oxygen therapy and nocturnal bi-level positive airway pressure (BiPAP) ventilation. During the night he had a traumatic rib fracture (5-11th right ribs) but still he used BiPAP ventilation during the sleep. In the morning after he presented with a diffuse and massive emphysema in the face, thorax and abdominal regions. On physical examination, the patient presented with massive swelling and crepitus on palpation. A chest computed tomography (CT) scan confirmed a diffuse subcutaneous emphysema and revealed a mediastinal emphysema and bilateral small pneumothorax. A fast resolution of the emphysema was of paramount importance as the patient was severely agitated due to his inability to open both eyes, and the need to reintroduce BiPAP ventilation as soon as possible. It was placed a fenestrated subcutaneous catheter on left hemithorax and a subcutaneous ostomy on right hemithorax for comparative purpose. It was also performed a confluent centripetal massage towards drainage orifices, with immediate and substantial improvement of emphysema, especially in left hemithorax, and progressive ocular opening. Further emphysema absorption occurred during hospitalization.

• MeSH
• Pulmonary Disease, Chronic Obstructive complications   therapy   MeSH
• Rib Fractures diagnostic imaging   MeSH
• Humans MeSH
• Mediastinal Emphysema diagnostic imaging   therapy   MeSH
• Oxygen Inhalation Therapy MeSH
• Tomography, X-Ray Computed * MeSH
• Aged MeSH
• Subcutaneous Emphysema diagnostic imaging   therapy   MeSH
• Continuous Positive Airway Pressure MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH