Department of Forensic Medicine, National Institute of Scientific Investigation, Korea. ykmoo@freechal.com

Department of Forensic Medicine, Catholic University Medical School, Korea.

Tension pneumoperitoneum (TP) is a rare fatal complication of colonoscopy. In a forensic point of view, this complication is hard to be diagnosed as a cause of death simply considering the result of autopsy findings without clinical information. We experienced an autopsy case expired by TP resulting from colonic perforation during colonoscopy. A 51-year-old woman was performed a colonoscopy under the sedation with propofol. The physician could not find any pathologic lesions throughout the whole colonic mucosa and noticed a perforation at sigmoid colon when he was about to wrap up his procedure. The patient was immediately transferred to the emergency department and showed distended abdomen with unstable vital signs. Although she was taken emergency exploratory laparotomy and simple closure of the perforated site, she died at 3 days after operation due to multiple organ failure. At autopsy, we could not find any other pathologic abnormality except for a wellsutured perforated site. However, the clinical findings and course enabled us to come to conclusion that the cause of death was TP. In conclusion, when conducting an autopsy on the death after colonoscopy, we should consider the possibility of TP by leakage of large amount of air during colonoscopy.

Key words : pneumoperitoneum, colonoscopy, complication, colon perforation