Korean J Gastroenterol.  2017 Sep;70(3):145-149. 10.4166/kjg.2017.70.3.145.

Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema after Diagnostic Colonoscopy

  • 1Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. mhs1357@cnuh.co.kr


Colonoscopy is a commonly performed endoscopic procedure. Although it is generally considered to be safe, serious complications, such as colorectal perforation, can occur. Most colonic perforations are intraperitoneal and cause pneumoperitoneum with acute abdominal pain as the initial symptom. However, extraperitoneal perforations with pneumoretroperitoneum may happen, albeit rarely, with atypical initial symptoms. We report a rare case of rectosigmoid perforation occurring after diagnostic colonoscopy that developed into pneumoretroperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema, with a change in voice and neck swelling as the initial symptoms. The patient was successfully treated with endoscopic closure of the perforation and conservative management.


Perforation; Pneumoretroperitoneum; Pneumomediastinum; Pneumothorax; Subcutaneous emphysema

MeSH Terms

Abdominal Pain
Mediastinal Emphysema*
Subcutaneous Emphysema*


  • Fig. 1 Contrast-enhanced computed tomography of the chest showing. (A) Pneumomediastinum, subcutaneous emphysema. (B) Pneumothorax.

  • Fig. 2 Erect abdominal x-ray showing pneumoretroperitoneum.

  • Fig. 3 Lateral neck x-ray showing prevertebral air and subcutaneous emphysema around the neck.

  • Fig. 4 Colonocopic finding. (A) The perforation was found at the rectosigmoid colon. (B) Endoscopic clipping was performed to close the perforation.


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