2015 Volume 53 Issue 6 Pages 810-816
The patient was a 70-year-old woman who underwent computed tomography colonography (CTC) during colon cancer screening. Bowel dilation was achieved using an automated carbon dioxide insufflator, and no subjective symptoms such as abdominal pain were noted either during or after the procedure. Imaging findings showed poor dilation associated with high-grade diverticulosis of the sigmoid colon, though no free gas, suggesting perforation, was observed. From the day after the investigation, the patient became aware of mild lower abdominal pain and developed a mild fever, but these were left untreated. Thereafter, the lower abdominal pain and fever persisted, and on Day 6 after the investigation, contrast CT and MRI showed abscess formation due to perforation of a sigmoid diverticulum. The patient was diagnosed with acute generalized peritonitis and underwent emergency surgery. Although CTC is a minimally invasive and safe investigation, it has been known to cause colonic perforation in rare cases. It is important to have an understanding of this, while learning the associated risk factors and preventive strategies. It is also important to aim for early detection of perforations, and a check-and-follow system should be developed for cases in which accidents occur. There have been no reports to date of cases of colonic perforation caused by screening CTC in Japan, so we are reporting this instructive case.
