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Colonic Perforation at CT Colonography in a Patient Without Known Colonic Disease

Brett M. Young1, Joel G. Fletcher2, Frank Earnest2, Jeff L. Fidler2, Robert L. MacCarty2, C. Daniel Johnson2, James E. Huprich2 and David Hough2

1 Mayo Clinic College of Medicine, Rochester, MN 55905.
2 Department of Radiology, Mayo Clinic Rochester, Mayo East 2-B, 200 First St. SW, Rochester, MN 55905.



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  		Fig. 1A —87-year-old man on anticoagulation medication for pulmonary emboli but without known colonic disease underwent CT colonography with automatic followed by manual insufflation. Supine axial CT colonography image shows normal-appearing cecum and periappendiceal tissues without evidence of perforation following conversion to manual insufflation.

 


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  		Fig. 1B —87-year-old man on anticoagulation medication for pulmonary emboli but without known colonic disease underwent CT colonography with automatic followed by manual insufflation. Subsequent prone axial CT colonography image shows free intraperitoneal air ventral to liver surface and retroperitoneally, posterior to hepatic flexure, indicating bowel perforation.

 


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  		Fig. 1C —87-year-old man on anticoagulation medication for pulmonary emboli but without known colonic disease underwent CT colonography with automatic followed by manual insufflation. Prone axial CT colonography image shows large amount of air dissecting along pericecal tissues, implicating cecum as likely site of perforation.

 


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  		Fig. 1D —87-year-old man on anticoagulation medication for pulmonary emboli but without known colonic disease underwent CT colonography with automatic followed by manual insufflation. Prone axial CT colonography image shows normal-appearing rectum and no evidence of rectal trauma.

 

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