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Detection of Occult Colonic Perforation Before CT Colonography After Incomplete Colonoscopy: Perforation Rate and Use of a Low-Dose Diagnostic Scan Before CO2 Insufflation

David M. Hough1, Martin A. Kuntz1,2, Jeff L. Fidler1, C. Daniel Johnson3, Bret T. Petersen4, James M. Kofler1 and Joel G. Fletcher1

1 Department of Radiology, Mayo Clinic, 200 First St. SW, Charlton 2, Rochester, MN 55905.
2 Present address: Department of Radiology, Carle Clinic, Urbana, IL.
3 Department of Radiology, Mayo Clinic, Scottsdale, AZ.
4 Department of Internal Medicine, Mayo Clinic, Rochester, MN.


Figure 1
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  		Fig. 1A —61-year-old woman who has undergone incomplete colonoscopy. Axial low-dose CT scan through pelvis obtained before CT colonography shows pneumatosis coli of sigmoid colon.

 

Figure 2
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  		Fig. 1B —61-year-old woman who has undergone incomplete colonoscopy. Scout view obtained before CT colonography shows intestinal gas and tiny gas pockets in pelvis that were inadequate for diagnosis of extraluminal gas.

 

Figure 3
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  		Fig. 2A —70-year-old woman who has undergone incomplete colonoscopy. Axial CT scans of abdomen obtained before CT colonography show extensive retroperitoneal gas secondary to colonic perforation.

 

Figure 4
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  		Fig. 2B —70-year-old woman who has undergone incomplete colonoscopy. Axial CT scans of abdomen obtained before CT colonography show extensive retroperitoneal gas secondary to colonic perforation.

 

Figure 5
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  		Fig. 2C —70-year-old woman who has undergone incomplete colonoscopy. Scout view from same examination as A and B shows extensive retroperitoneal air.

 

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