Serosal laceration: A complication of intra-operative colonoscopy explained by transmural pressure gradients

Two cases of serosal laceration of the colon during intra-operative, open-abdomen colonoscopy are described. To determine causative factors, intraluminal and intra-abdominal pressures were measured during routine closed-abdomen colonoscopy. Both pressures were found to be low and to increase with the duration of the procedure. During intra-operative open-abdomen colonoscopy increases in intraluminal pressure are unopposed by concomitant increases in intra-abdominal pressure in contrast to circumstances pertaining at closed-abdomen colonoscopy. The open abdomen may have permitted a colon transmural pressure gradient to develop that was in part responsible for the serosal lacerations in the cases described.