Table 1.

Reported cases of extraperitoneal and combined colonic perforation after diagnostic and therapeutic colonoscopy

Pts	First author, year	Procedure type	Time of onset of symptoms	Clinical features	Imaging findings			Site of perforation	Management
					PP*	PT*	PM*
1	Our case	Colonoscopy with sigmoid biopsy, history of UC	24 h	Subcutaneous emphysema	Yes	No	Yes	Transverse colon	Laparotomy and subtotal colectomy with end ileostomy
					Pneumopericardium
2	Yang, 2016	Colonoscopy with resection of rectal adenoma	Immediate	SOB, subcutaneous emphysema	Yes	Yes	Yes	Rectum	Conservative
3	Patel, 2015	Flexible sigmoidoscopy with SEMS deployment	1 day	Asymptomatic	No	Yes	Yes	Sigmoid	Conservative
4	Palomeque, 2015	Colonoscopy	Immediate	Abdominal pain, nausea and vomiting	Yes	Yes	No	Rectosigmoid	Primary closure of perforation
5	Mihatov, 2015	Colonoscopy with Biopsy for CD	9 days	Sudden onset chest pain and dyspnea	No	No	Yes	Unknown	laparoscopic subtotal colectomy
6	Ahmed, 2014	Colonoscopy with biopsies for CD	Immediate	Scrotal swelling, abdominal pain	Yes	Yes	Yes	Unknown	Subtotal colectomy
7	Pourmand, 2013	Colonoscopy	Immediate	SOB, abdominal pain, chest pain	Yes	Yes	No	Unknown	Conservative
8	Denadai, 2013	Colonoscopy with rectal polypectomy	3 days	Neck swelling, malaise, neck crepitus	No	No	Yes	Rectum	Conservative
9	Loughlin, 2012	Colonoscopy with biopsy for UC	6 h	Neck pain and crepitus, odynophagia	No	No	Yes	Unknown	Conservative
10	Albert, 2012	Colonoscopy	Immediate	Asymptomatic	Yes	Yes	Yes	Sigmoid	Operative
11	Marariu, 2012	Colonoscopy	Several hours	Chest pain, emphysema of neck, face, chest	Yes	No	Yes	Unknown	Conservative
12	Evangelos, 2012	Colonoscopy	Immediate	Abdominal pain, neck, face and left orbit swelling	Yes	No	Yes	Sigmoid	Laparotomy with sigmoid resection
13	Kwang, 2011	Colonoscopy	2 days	Abdominal pain, neck swelling	No	No	Yes	Rectum	Conservative
14	Chan, 2010	Colonoscopic balloon dilatation	Immediate	Oxygen desaturation, neck swelling, cyanosis	Yes	Yes	Yes	Sigmoid	Conservative
15	Cappello, 2010	Colonoscopy, history of UC	1 h	Face and neck swelling, abdominal pain, fever	Yes	No	Yes	Cecum	Laparotomy with right hemicolectomy
16	Kipple, 2010	Colonoscopy with sigmoid polypectomy	8 h	Abdominal pain, dyspnea, neck swelling	Yes	Yes	Yes	Sigmoid	Operative resection of perforated segment
17	Fazeli, 2009	Colonoscopy with random biopsies	15 min	Respiratory distress and swelling of face, neck	No	No	Yes	Sigmoid	Laparotomy and resection of perforated segment
18	Konstantinos, 2008	Colonoscopy with rectal polypectomy	24 h	Hoarseness, neck swelling	No	No	Yes	Rectum	Conservative
19	Marwan, 2007	Colonoscopy	Immediate	Emphysema of face, chest, abdomen	Yes	Yes	Yes	Unknown	Conservative
20	Nark-Soon, 2007	Colonoscopy	Not specified	Abdominal pain, neck swelling, dyspnea	Yes	No	Yes	Sigmoid	Colonoscopic clip placement
21	Zeno, 2006	Colonoscopy	Immediate	Abdominal pain, vomiting	Yes	Yes	No	Sigmoid	Laparotomy with hemicolectomy
22	Shallaly, 2005	Sigmoidoscopy with rectal biopsy	2 h	Neck swelling, dysphagia, voice change	No	No	Yes	Rectum	Conservative
23	Mastrovich, 2004	Colonoscopy with cecal polypectomy	Immediate	Facial fullness, SOB	Yes	No	Yes	Unknown	Conservative
					Pneumopericardium
24	Hirofumi, 2002	Colonoscopy with rectal tumor biopsy	2 h	Facial edema, emphysema in neck	No	No	Yes	Sigmoid	Laparotomy and sigmoid colon resection
					Pneumopericardium
25	Webb, 1998	Colonoscopy	30 min	Neck, facial, periorbital edema, SOB	No	Yes	Yes	Unknown	Conservative
26	William, 1996	Colonoscopy with sigmoid polypectomy	1 h	Facial edema, chest pain, emphysema in neck, chest	No	Yes	Yes	Sigmoid	Conservative
27	Ho, 1996	Colonoscopy with cecal polypectomy	Immediate	Substernal chest pain	Yes	Yes	Yes	Cecum	Laparotomy with right hemicolectomy
28	Fitzgerald, 1992	Colonoscopy with polypectomy, history of UC	9 h	Neck swelling, voice change, abdominal discomfort	Yes	No	Yes	Transverse colon	Laparotomy with primary closure
					Pneumopericardium
29	Bakker, 1991	Colonoscopy with rectal polypectomy (prior Ileo-transversotomy)	2 h	Abdominal pain	Yes	No	Yes	Ileocolostomy site	Laparotomy with primary closure
					Pneumopericardium
30	McCollister, 1990	Colonoscopy with cecal polypectomy	7 h	Abdominal pain, neck swelling, SOB	Yes	No	Yes	Cecum	Conservative
31	Foley, 1982	Sigmoidoscopy	30 min	Neck pain and swelling, retrosternal pain	No	No	Yes	Sigmoid	Conservative
32	Amshel, 1982	Colonoscopy with sigmoid polypectomy	Few hours	Asymptomatic, low grade fever	Yes	No	Yes	Sigmoid	Conservative

PP, pneumoperitoneum; PT, pneumothorax; PM, pneumomediastinum; UC, ulcerative colitis; CD, Crohn disease; SEMS, self-expanding metallic stent; SOB, shortness of breath.