Colonoscopy is being widely used since the 1980s and is the leading diagnostic procedure for colorectal cancer. For many colorectal diseases, it is also a therapeutic tool. Like many other procedures in Medicine, it has its drawbacks and complications, some of which if not readily diagnosed can represent a serious risk to the patient's health and well-being. We describe a case of colon perforation during diagnostic colonoscopy in a patient, resulting in exuberant pneumoretroperitoneum, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema, who successfully underwent laparoscopic colonic resection with primary anastomosis. There are only a few cases of combined intraperitoneal and retroperitoneal perforations described in the literature.
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