A 73-year-old woman underwent a screening colonoscopy. It was performed under moderate sedation with 75 mcg of fentanyl and 5 mg of midazolam given intravenously. The colonoscope was advanced to the cecum without difficulty. The exam was normal except for pandiverticulosis. The medical staff noted that the patient had mild left-sided abdominal pain shortly after the procedure which improved after passing gas and she was considered suitable for discharge.
Five hours after the procedure she called the endoscopist reporting increasing left-sided abdominal pain. There was no associated nausea, vomiting, fever, chills, dyspnea, or left shoulder pain. She was reevaluated in the endoscopist’s office. Concern for colonic perforation prompted a CT scan of the abdomen and pelvis, done without intravenous contrast which revealed the causative factor of the abdominal pain (Image attached). What is…
