A Case of Mediastinal and Retroperitoneal Emphysema of the Descending Colon After a Colonoscopy that Could be Treated Conservatively

Abstract

A 76-year-old woman was admitted to our hospital with melena. She had an autoimmune disease and had been prescribed steroids and immunosuppressive drugs for a long time. Colonoscopy revealed massive bleeding from the diverticulum of the descending colon, and endoscopic hemostasis was successful. Five days later, bleeding developed from the same diverticulum again, which required endoscopic hemostasis. On the day following the second colonoscopy, high fever developed without abdominal symptoms. The laboratory data showed a significant inflammation reaction. A computed tomography scan showed massive pneumoretroperitoneal, pneumomediastinal, subcutaneous emphysema without pneumoperitoneum. A contrast enema study showed the absence of perforation. We chose conservative treatment, and the clinical course was uneventful. She was discharged 18 days after initial observation. Retroperitoneal emphysema after colonoscopy is a rare complication. It is suggested that more cases with retroperitoneal emphysema after colonoscopy can potentially be treated without operation.