When perforation is not the culprit : case report and systematic review of mechanical small-bowel obstruction complicating colonoscopy.

Colonoscopy is generally safe, although expansion of colorectal cancer prevention programs is likely to increase the number of post-colonoscopy complications. We report the case of a 42-year old woman with a prior history of 2 cesarean section deliveries who developed abdominal pain after an otherwise uneventful screening colonoscopy. Urgent exploration revealed closed-loop obstruction involving the terminal ileum, caused by an adhesive band close to the site of her previous Pfannenstiel incision. A systematic review of the literature revealed 11 reports (1985-2008) describing a total of 13 cases of mechanical small bowel obstruction (MSBO) after colonoscopy, 9 of which were confirmed by laparotomy. Colonoscopy-induced MSBO is practically impossible to anticipate, and only a prior history of abdominal/pelvic surgery may be deemed as a predisposing factor. However, it is related to significant morbidity, as it often leads to an ischemic bowel with need for surgical resection. Thus, endoscopists should be aware and maintain a low operative threshold to this rare, but hazardous, complication of colonoscopy.