Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy, with an incidence ranging from 0.016% to 8% depending on the type and purpose of the procedure. Several patient-related, endoscopist-related, and procedure-related factors increase the risk of ICP, which most commonly occurs in the sigmoid colon. Following specific guidelines for colonoscopy performance and quality can help prevent ICP. Early diagnosis is essential, and imaging modalities such as radiography or CT scan may be needed to evaluate the extent of damage. The management of ICP depends on the size and location of the perforation, the presence of peritonitis or sepsis, the underlying colon pathology, and the patient's general condition. Endoscopic, surgical, or conservative methods may be used, but surgical consultation should always be sought urgently. Surgery is usually indicated for large perforations, signs of peritonitis, inadequate bowel preparation, severe comorbidity, failure of conservative treatment, underlying colon disease requiring surgery, transplant recipients, or immunocompromised patients. Laparoscopic-assisted exploration is the preferred surgical technique for ICP. The timing of a follow-up colonoscopy depends on the indication for the initial colonoscopy that led to ICP.

As trauma is the leading cause of mortality and related complications in Iran, colon rupture and injury during trauma is of much importance as well. In present study through a three-year epidemiological study, cases of colon ruptures and injuries along with the diagnostic and therapeutic approaches in Isfahan Al-Zahra and Kashan Shahid Beheshti hospitals were reviewed. During a three-year period (2007-9), a number of 28 patients with post-traumatic colon ruptures were studied in two educational hospitals of Isfahan and Kashan. This retrospective survey was based on the patients’ medical records. Collected data was included of sex, age, cause and site of rupture, clinical manifestations, type of surgical treatment, mortality, and length of hospital stay. Fourteen patients (50%) had penetrating and another 14 ones (50%) blunt traumas. Mean age for the penetrating and blunt traumas were 26/21 ±11/98 and 35/07 ±16/8 years, respectively. The most reported injury sites were sigmoid and transverse colon for blunt and penetrating traumas, respectively. Colostomy with or without repair has often been performed for the penetrating traumas. One penetrating trauma case (7/2%) and 5 blunt trauma cases (35/7%) have deceased in the hospital. In terms of the severity of peritonitis, in penetrating trauma patients, 10 cases (71/4%) and 4 cases (28/5%)) were in stage I and stage IV, respectively, but for blunt traumas, 12 cases (85/7%) and one case (7/2%) and one case (7/2%) were in stage I, stage III, and stage IV, respectively, with no significant difference between the two groups. Average length of hospital stay was 13/07±7/97 (range 6-28) days for penetrating traumas and 11/71±9/8 (range 6-40) days for blunt traumas, with no significant difference between two groups. Summing up, the study demonstrates that cases of post-traumatic colon rupture are in accordance with other causes of colon rupture in terms of mortality. In spite of the suggestions of reference texts and regarding the lower severity of the peritonitis, in most penetrating traumas, surgeons still resort to colostomy as a supporting factor for repairing or even as an independent treating approach.

Acute pseudo–obstruction of the colon or ogilvie syndrome results in massive colonic dilatation that may lead to a life threatening perforation. Pseudo–obstruction are terms used to denote a condition in which patients appear to have signs and symptoms suggestive of intestinal obstruction without an evident mechanical source. This problem is often seen in association with other diseases and occasionlly complicates the post-operative course of patients who have under gone one of several typesof operations, particulary abdominal surgery. Predisposing factors include different medical and surgical illness. Renal failure and Kidneay transplantation are perdisposing factors: The presented case was a complication of renal failure, who was diagnosed and operated because of peritonitis secondary to cecal perforation. Colonic decompression by means of colonoscopy is the most effective therapeutic modality for pseudo – obstruction of colonic dilation. If the bowel is ischemic or perforated, surgical intervention will be indicated.

Colonic pseudo-obstruction (ogilvies syndrome) is a rare post surgical complication that can be associated with cesarean delivery. Its pathophysiology remains poorly understood and patients are still treated inappropriately. This syndrome characterized by acute colonic dilatation without mechanical obstruction if undiagnosed and treated in appropriately, it may cause colonic perforation with mortality rate as high as 50 percent. we report a case after cesarean.Case report: A 30 years old woman, prime gravid, undergone elective cesarean section. On first day postoperative, she developed abdominal distention. She had intermittent flatus and stool. X ray showed some colonic dilatation. She was given bisacodyl suppository and had some improvement. On fifth day, she becomes ill with severe distention and pneumo-peritoneum on X-ray. At the operation that soon followed, small perforation was found in the cecum with generalized peritonitis. Tubocecostomy and irrigation was performed. Post operative she was well and discharged after 7 days. Surgeons should consider ogilvies syndrome in the patient whose abdomen becomes distended post operation. Delay in treatment cause ischemia, necrosis and perforation with high mortality. Early recognition and appropriate treatment decrease mortality and morbidity rate.

Intrauterine device (IUD) is an effective and reliable contraceptive method. It is one of the most frequently used methods in our country. Colon perforation is a rare but serious complication occurring sometimes years after insertion. In this report, a patient with cecum perforation following IUD insertion who presented with acute abdomen was reported.

The patient was a 30 year old female who admitted to the clinic of Arash Women's Comprehensive Hospital with complaints of hypogastric abdominal pain and spotting. She had a natural vaginal delivery 6 months ago and an IUD was inserted one week before referring. On abdominal examination, there was pain in the hypogastric region with deep palpation and there was positive cervical motion tenderness. Abdominal ultrasonography did not show IUD in uterine cavity. Abdominal X-ray was done and IUD was seen in abdominal cavity. Emergent Laparascopy was done. Two cecum perforations by an intrauterine device were diagnosed, and the intestinal damage was repaired with a laparatomic approach.

IUD migration and uterine and colon perforation is a rare but serious complication that should be considered in differential diagnosis of each woman with IUD who has abdominal pain. Laparoscopic approach for intrauterine device removal is a simple and safe approach if further complications are not likely.

COLONOSCOPY OVERVIEW — A colonoscopy is an exam of the lower part of the gastrointestinal tract, which is called the colon or large intestine (bowel). Colonoscopy is a safe procedure that provides information other tests may not be able to give.Colonoscopy is performed by inserting a device called a colonoscope into the anus and advanced through the entire colon. The procedure generally takes between 20 minutes and 1 hour.REASONS FOR COLONOSCOPY — The most common reasons for colonoscopy are to evaluate the following:•As a screening exam for colon cancer •Rectal bleeding •A change in bowel habits, like persistent diarrhea •Iron deficiency anemia (a decrease in blood count due to loss of iron) •A family history of colon cancer •As a follow-up test in people with colon polyps or colon cancer •Chronic, unexplained abdominal or rectal pain •An abnormal X-ray exam, like a barium enema or CT scanTHERAPEUTIC COLONOSCOPYThe most common reasons are the following: Polypectomy, Band ligation of hemorrhoids, Injection or cautery techniques for the treatment of diverticullum with active bleeding or a visible vessel or a vascular ectasia.COLONOSCOPY COMPLICATIONS — Colonoscopy is a safe procedure, and complications are rare but can occur:•Bleeding can occur from biopsies or the removal of polyps, but it is usually minimal and can be controlled. •The colonoscope can cause a tear or hole in the colon. This is a serious problem, but it does not happen commonly. •It is possible to have side effects from the sedative medicines. Although colonoscopy is the best test to examine the colon, it is possible for even the most skilled doctors to miss or overlook an abnormal area in the colon.

Pneumatosis intestinalis is usually benign condition which may affects any segment of gastrointestinal tract from stomach to rectum. It is also called pneumatosis cystoides intestinalis (PCI). It is best classified in to (A) a primary form and (B) a secondary form. Air cysts are found mostly in subserosa of large bowel. The aim of this study is to present 72-year–old heavy smoker man that refers to emergency department with abdominal pain, nausea, vomiting and decreased appetite for three days duration. With impression of peritonitis due to hallow viscus perforation, patient underwent laparotomy. Abdomen was completely clean without any puss or fluid. There were multiple gas-containing cysts over the antimesentric colonic wall of the transverse and sigmoid colon. We terminated the operation without any intervention. The patient became symptom free post operatively and discharged from hospital with good condition.

The diaphragm is the main respiratory muscle; the diaphragm can rupture in the field of blunt trauma, penetrating trauma or occur following medical procedures. Approximately 0.8 to 1.6% of patients with blunt trauma are suspected to have a rupture of the diaphragm. As diaphragmatic rupture is a rare clinical condition, so it may be undiagnosed and associated with complications and high mortality and morbidity.
Case report: In this study we report a 53-year-old man, with history of blunt trauma five years ago, but during this period, remained undiagnosed. For shortness of breath, he visits physicians frequently and just receives medical treatment during these years. Finally, requested abdominal X-ray showed diaphragmatic rupture and herniation of the left side of the colon into the thoracic area.
Having a strong clinical suspicion, taking a thorough history of the patient, performing an accurate physical examination and doing an essential diagnostic procedures should all be considered to help confirm the diagnosis.

Two patients with iatrogenic femoral neck fracture following intramedullary fixation of the diaphyseal fractures are reported. This is a rare complication of intramedullary nailing (IMN)، has poor prognosis and is preventable. It seems that choosing the piriformis fossa as the entry point، increased neck-shaft angle (coxa valga) and excessive nail insertion increased the risk of the iatrogenic neck fracture.