Gas explosion

Q: A gas explosion during a colonoscopy is a possibility.

A) True

B) False

Answer: A

A gas explosion during a colonoscopy is a rare but dreaded complication. Due to poor bowel prep, hydrogen or methane gas may be retained in the colonic lumen, and ignition from electrosurgical energy may cause a gas explosion. An alternative reason is the use of incompletely absorbable carbohydrate preparations, such as lactulose, mannitol, or sorbitol, which can serve as substrates for colonic bacteria, leading to fermentation and the production of high levels of combustible gases, including hydrogen and methane. 

One interesting case of a gas explosion is reported without the use of bowel preparation in a patient with colectomy for Gardner syndrome, who was found to have rectal polyps on proctoileoscopy. The polyps were treated with APC, which resulted in a gas explosion.

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References:

1. Manner H, Plum N, Pech O, et al. Colon explosion during argon plasma coagulation. Gastrointest Endosc 2008; 67:1123.

2. Tontini GE, Rimondi A, Pessarelli T, Ciprandi G, Kurihara H, Sorge A, Vecchi M. Clinical features and risk factors for colorectal gas explosion during digestive endoscopy and surgery: a systematic review. Surg Endosc. 2025 Jan;39(1):384-393. doi: 10.1007/s00464-024-11370-0. Epub 2024 Nov 15. PMID: 39548011; PMCID: PMC11666635.

3. Lin OS, Biehl T, Jiranek GC, Kozarek RA. Explosion from argon cautery during proctoileoscopy of a patient with a colectomy. Clin Gastroenterol Hepatol 2012; 10:1176.

4. Ladas SD, Karamanolis G, Ben-Soussan E. Colonic gas explosion during therapeutic colonoscopy with electrocautery. World J Gastroenterol. 2007 Oct 28;13(40):5295-8. doi: 10.3748/wjg.v13.i40.5295. PMID: 17879396; PMCID: PMC4171316.