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September 12, 1980

Acute Onset of Dyspnea Associated With Colonoscopy

JAMA. 1980;244(11):1239-1240. doi:10.1001/jama.1980.03310110049031

WE PRESENT this case to demonstrate that the increase in abdominal pressure associated with colonoscopy may result in visceral herniation through a chronic diaphragmatic defect.

Report of a Case  A 67-year-old man was referred for colonoscopy because a sigmoid polyp had been demonstrated by barium enema examination. He was otherwise in good health and denied previous illness or injury except for blunt upper abdominal trauma and several rib fractures during an automobile accident in 1939. Subsequent chest roentgenograms had shown an elevated right hemidiaphragm.During the colonoscopy, a 1.5-cm polyp on a long stalk was transected from the sigmoid colon with electrocautery. Shortly thereafter, the patient complained of sudden dyspnea and asked to sit up. Breath sounds were diminished in the right hemithorax. The abdomen was moderately distended but nontender, and the liver was palpable 7 cm below the costal margin. Initially, bowel sounds were absent but were later noted