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Serosal laceration: A complication of intra-operative colonoscopy explained by transmural pressure gradients

1978; Elsevier BV; Volume: 24; Issue: 5 Linguagem: Inglês

10.1016/s0016-5107(78)73521-2

1097-6779

Randi Sjogren, Lawrence F. Johnson, Melvin L. Butler, Howard A. Heit, Daniel E. Gremillion, Richard C. Cammerer,

Diverticular Disease and Complications

Two cases of serosal laceration of the colon during intra-operative, open-abdomen colonoscopy are described. To determine causative factors, intraluminal and intra-abdominal pressures were measured during routine closed-abdomen colonoscopy. Both pressures were found to be low and to increase with the duration of the procedure. During intra-operative open-abdomen colonoscopy increases in intraluminal pressure are unopposed by concomitant increases in intra-abdominal pressure in contrast to circumstances pertaining at closed-abdomen colonoscopy. The open abdomen may have permitted a colon transmural pressure gradient to develop that was in part responsible for the serosal lacerations in the cases described. Two cases of serosal laceration of the colon during intra-operative, open-abdomen colonoscopy are described. To determine causative factors, intraluminal and intra-abdominal pressures were measured during routine closed-abdomen colonoscopy. Both pressures were found to be low and to increase with the duration of the procedure. During intra-operative open-abdomen colonoscopy increases in intraluminal pressure are unopposed by concomitant increases in intra-abdominal pressure in contrast to circumstances pertaining at closed-abdomen colonoscopy. The open abdomen may have permitted a colon transmural pressure gradient to develop that was in part responsible for the serosal lacerations in the cases described.