DISCUSSION
An irretrievable colonoscope secondary to looping is an exceedingly rare
complication of colonoscopy; the presence of previous abdominal surgery
is a risk factor for procedural difficulty and
incompleteness1-3. Significant looping and angulations
are reported to cause the colonoscope to be difficult to advance or
retrieve, requiring a laparotomy to withdraw it2-4.
In this case report, the rare complication of colonoscope’s migration in
the chest cavity was associated to the presence of a late TDH. The TDH
is more commonly associated with blunt abdominal injury like road
traffic accident and fall from height when compared with penetrating
abdominal injuries and has higher tendency to increase in size and
include abdominal organs as the increasing abdominal pressure causes the
abdominal content to herniate into the pleural cavity which has
relatively lower pressure5.
It is not uncommon for the TDH to remain asymptomatic and have a delayed
presentation with potentially serious consequences, as demonstrated by
this case.
The literature shows few cases reported of colonoscopes stuck in
incarcerated hernias which required surgical management and none of the
reported cases were diaphragmatic hernias2-4.
In these cases, a meticulous planning is essential, and it involves a
collegial team discussion with different specialist. The surgical
strategy should focus on the retrieval of the colonoscope with
simultaneous reduction of the TDH; this may represent a challenging
situation in view of the previous abdominal adhesions.
In this case report, despite the colonoscope was easily withdraw per
rectum, after temporary reduction of the hernial sac, the TDH could not
fully be reduced in the abdomen., for the hard adhesion on the abdominal
versant. A limited enlargement of the hernial orifice was performed
respecting the hernial contents in a view to avoid any future
strangulation; this enlargement was also limited to prevent future
progression of the herniation process.