Supplementary Material for: Laparoscopic treatment of iatrogenic serosal lacerations during colonoscopy – case report of a rare complication

Introduction
Iatrogenic colonic perforation following diagnostic colonoscopy is rare (0.016-0.8%) but carries significant morbidity. Reported mechanisms include direct mechanical injury, thermal damage or barotrauma. Management options range from immediate endoscopic treatment to surgical intervention or clinical observation.
Case Presentation
A 49-year-old asymptomatic female patient underwent a screening colonoscopy. During the procedure, altered mucosal perfusion of the ascending colon was suspected, prompting referral to the Emergency Department. Imaging revealed a large pneumoperitoneum. Diagnostic laparoscopy identified serosal lacerations of the ascending colon with a punctiform perforation. An invaginating suture was performed to reinforce the fragile areas of the colon. The postoperative course was uneventful, and the patient remained asymptomatic at 10-month follow-up.
Discussion/Conclusion
Serosal laceration is a rare complication, usually related to increased intraluminal pressure during colonoscopy. In the presence of atypical endoscopic findings, hyper pressure-related injury should be considered. Early recognition is essential to reduce the morbidity associated with iatrogenic colonic perforation.

引言
诊断性结肠镜检查术后的医源性结肠穿孔（iatrogenic colonic perforation）发病率为0.016%~0.8%，虽较为罕见，但可引发显著的不良预后。目前已报道的致病机制包括直接机械性损伤、热损伤及气压伤（barotrauma）。治疗方案跨度较大，涵盖即刻内镜治疗、外科手术干预乃至临床保守观察。

病例报告
1例49岁无症状女性患者接受筛查性结肠镜检查。操作过程中，医师怀疑升结肠黏膜灌注异常，随即转诊患者至急诊科。影像学检查提示存在大量气腹（pneumoperitoneum）。诊断性腹腔镜探查可见升结肠浆膜层撕裂，伴点状穿孔。术者行内翻缝合术加固结肠薄弱区域。患者术后病程平稳，随访10个月时仍无不适症状。

讨论与结论
浆膜层撕裂是一类罕见并发症，多与结肠镜检查过程中肠腔内压力升高相关。当内镜下表现不典型时，需考虑高压相关性损伤。早期识别对于降低医源性结肠穿孔相关的不良预后至关重要。