Introduction: Colonoscopy-related perforation is a rare but potentially life-threatening complication.
Intraoperative identification of the perforation site remains a major surgical challenge,
especially in patients without overt signs of peritonitis or those with significant
visceral obesity ([Abb. 1 ]
[2 ]
[3 ]).
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Objectives: We aimed to introduce and assess a novel intraoperative technique—a modified bubble
test—for the detection of colonoscopic perforations, with particular emphasis on right-sided
colonic injuries.
Methods: Two cases of suspected colonoscopic perforation were managed using the modified bubble
test. A small laparoscopic incision was created at the appendiceal base, allowing
the insertion of a Robinson drain. The peritoneal cavity was filled with sterile saline,
and controlled CO₂ insufflation through the drain facilitated real-time visualization
of escaping air bubbles, indicating the site of perforation.
Results: In the first case, the modified bubble test successfully localized a perforation
at the hepatic flexure, which was then repaired primarily. In the second case, the
absence of bubble formation ruled out a free perforation, a finding confirmed by further
exploration. Both patients had uneventful postoperative recoveries without complications.
Conclusion: The modified bubble test offers a simple, cost-effective, and reproducible method
for intraoperative assessment of colonic integrity. It allows prompt and accurate
detection of perforation sites, particularly in challenging right-sided cases, potentially
obviating the need for intraoperative colonoscopy. Further prospective studies are
warranted to validate its efficacy and broader application.
