Case Highlights Links Between Colonoscopy Prep and Esophageal Rupture

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Case report describes 71-year-old man with severe epigastralgia and dyspnea after drinking PEG
Case report describes 71-year-old man with severe epigastralgia and dyspnea after drinking PEG

HealthDay News — Esophageal rupture can occur in association with colonoscopy preparation, according to a letter to the editor published in the March issue of the Journal of the American Geriatrics Society.

Yoshitaka Nishikawa, MD, from Kyoto University in Japan, and colleagues describe the case of a 71-year-old man who presented with lower gastrointestinal bleeding three days after endoscopic mucosal resection for a cecal adenoma. He was scheduled to undergo urgent colonoscopy; he presented with severe epigastralgia and post-vomiting dyspnea after drinking 2,000 mL of polyethylene glycol (PEG) electrolyte solution. Mediastinal emphysema and left pleural effusion were revealed on computed tomography.

Esophagography was performed after emergency thoracic drainage. The authors found that the mediastinal space was penetrated by contrast media, which extended into the left thoracic cavity, indicating esophageal rupture. In emergency surgery, the rupture was detected in the lower esophagus and sutured successfully. The patient recovered gradually and was discharged two months after surgery.

"Although there are several causes of esophageal perforation, only a few spontaneous esophageal perforation cases associated with PEG electrolyte solution for colonoscopy preparation have been reported," the authors write. "Clinicians should be aware of this potentially lethal complication of routine preparation for colonoscopy, especially in elderly adults."

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