Rupture of Colon During Colonoscopy

Q: Please help me. My mom had a colon perforation during a colonoscopy on 6-21-2013. Immediate surgery was done to fix perforation. Doctors realized she was getting an infection due to classic symptoms, including red streaks going from both sides of her incision across her stomach and down to waist. Culture came back E coli but I do not know what strain because doctors didn’ tell about it. She was started on Avelox intravenously 4 days ago. Things seemed to be getting better but now a new red streak is forming from her incision. There is frequent twitching pain throughout the length of her finger just underneath the red streak. Does this mean new infection is spreading? They are trying to send her home today.
-By Todd

Reply:

Yes, it is possible that there is some infection. It may be the old infection or some new one.

Your mom needs to be evaluated. She needs further medication with relevant antibiotics. This condition needs to be attended with urgency.

Also, the cause of infection needs to be detected. It is possible that the perforation has not been sealed adequately. An exploratory laproscopy may be required.

Gastrointestinal perforation is always a surgical emergency. It may occur in the colon, stomach, small intestine or anywhere else.

What Is a Gastrointestinal Perforation?

A leak in the wall of the GI tract, anywhere throughout its length is called a perforation.

It may occur due to surgical procedures like colonoscopy, trauma due to sharp food stuff like bones, unattended ulcers etc.

The affected part of GI often has a weakened wall. This may be due to some underlying disease like crohn’s or ulcerative colitis, any growth or biopsy procedures.

Identifying a Perforation

The belly becomes tender and rigid like a board. This is because intestinal contents leak out from it and spill in the peritoneal cavity.

Heart sounds can sometimes be heard over the whole abdomen. The patient is unable to pass stools or flatus.

This condition is always an emergency. Infections spread very quickly in the peritoneal cavity. This is called peritonitis.

Take Care,

Buddy M.D.

Medical Advice (Q&As) on “Colonoscopic Perforation

  1. Todd

    I had a previous question answered regarding my mom’s perforated colon during surgery/HAI ecoli infection in open wound, and I sincerely appreciate the answer. My mom is still having troubles with infections. It’s been ten days since DC from hospital with ecoli infection in her open wound. She is changing the saline soaked gauze 2X’s/day. The gauze, for the last two days (4 dressing changes) has been soaked with bright red blood. She even had to apply more gauze, between changes, on top because the blood was soaking through the packed gauze and the top pad covering the open wound. Yesterday the blood had stopped and it was just the same pus on her gauze. She had her first post-op appointment today, no blood test, no swab of wound/pus, just a visual check of wound, and was told that it was normal healing. Would normal healing cause there to be that much bright red blood in her open wound, and then just stop only for pus to return? Could this be something more serious like capillary leak syndrome? Thank you for your time.

    Reply
    1. Buddy M.D. Post author

      Inform us about the surgical procedure that was done to repair the colon perforation.

      Was it through a laparoscope or they required to open the abdomen? What was the size of the incision?

      Usually, any surgical wound takes not more than a week to get healed. An incompletely healed wound may get infected.

      Signs of an infected wound

      Pain in and around the incision
      Fever with chills
      Discharge, pus or blood, from the incisional wound
      Changes in blood TLC counts

      Is your mother able to take her diet orally?

      Reply
      1. Todd

        Yes, they had to cut her open; vertical incision approx. 6-8″long. It was HAI and they told my parents it was ecoli, but never told them the strain even when asked several times. All they told them was, “It’s just ecoli.” The 5-6 of the incision that was left open to heal on its own still has pus and some days blood on the gauze when they change the dressings 2x/day. When you look down at the base of the open wound there is a he and it appears to be through the stomach wall and you can see intestine, but they told them it was just fatty tissue? Thanks.

        Reply
        1. Buddy M.D. Post author

          A big incision like this will take time to heal. It is common for such incisions to get infected.

          You need to take proper care of the incision. It should be cleaned twice daily with antiseptics. At the moment, it does sound infected, since you have mentioned frank pus coming out of it.

          Your mother requires antibiotics right now. For proper healing of the wound, take care of the following points:

        2. A lot of rest! She needs to rest a lot and avoid all strenuous activities.
        3. Her diet should be such that there is no straining at stools, no pressure or pull on the surgical wound.
        4. Signs of infection need to be monitored carefully. They are redness, swelling, pain and warmth over the incisional area. These signs should get better each day.
        5. The pus or blood being drained should reduce gradually.
        6. Wound care needs to be done very nicely on a twice daily basis.
        7. Her diet should be good enough to promote healing.
        8. If she gets fever or feels chills in her body, it is an indication that the infection is spreading. Report any such symptom to your doctor immediately.

          Recovery is expected to take time. Such incisions are slow to heal due to poor blood supply of the area and their location.

          Reply
  2. renu

    I have operation of exploratory laparotomy with operative drainage of pelvic cyst with serosal metastatic changes with resection of bowel mass (sigmoid colectomy) and Hartmann’s operation of colostomy. Can the original path of stool be again set up? Moreover, is that mass a cancerous tumor? During operation it was found that mass contained liquid. My CA-125, T3, T4, TSH are 16,135,8.72,7.50.

    Reply
    1. Buddy M.D. Post author

      Though it is difficult to restore the original pathway of stools, you may talk to your surgeon about the possible ways.

      There are chances that the mass was malignant, or may be it had a tendency to be one. The exact diagnosis would require a histopathological study of the resected mass.

      Reply
      1. renu

        The biopsy report shows multicystic peritoneal mesothelioma, serosa of sigmoid colon. Resection margins of both of the segments with no tumor. Muscular wall and mucosa of colon are not involved by tumor. What does this mean? What is the treatment of this? Where best treatment is available in India?

        Reply
        1. Buddy M.D. Post author

          This is malignancy. A major surgery is required, where all the portions of the bowel involved are resected.

          Reply
          1. Buddy M.D. Post author

            You need to look for a proper hospital set up. Make sure they have all facilities like, well equipped operation theater, blood bank, histopath labs etc.

  3. Sheila

    I’m suppose to go for a colon test. They are going to use propofol. I’m nervous and don’t no why I’ve had 2 surgeries before with propofol. Will I be OK?

    Reply