“Cat Scratch Colon” and Cecal Barotrauma perforation during colonoscopy using CO(2) insufflation

Cecal perforation due to barotrauma is an increasingly recognized complication of colonoscopy when using room air for insufflation. CO(2) is increasingly being utilized for insufflation due to more rapid absorption compared to ambient air and results in reduced post-procedural pain and flatulence. Use of CO(2) is thought to protect against barotrauma injury, and use of CO(2) during endoscopy has not previously been reported to cause barotrauma perforation during colonoscopy. We present a case of cecal perforation secondary to barotrauma during routine screening colonoscopy with CO(2).