Diagnosis: Post Colonoscopic Bowel Perforation in Underlying Secondary Amyloidosis

What is your diagnosis? A 59-year-old woman was referred with nausea, vomiting and generalized abdominal pain after colonoscopy. She is a known case of amyloidosis for 10 years that resulted in renal failure. (Figs. 1. A-F) Fig. 1. A 59-year-old woman with nausea, vomiting and generalized abdominal pain after colonoscopy. A. Plain abdominal graphy shows dilation of bowel loops and air in the subdiaphragmatic and retroperitoneal area. B-F. Contrast enhanced abdominopelvic CT scan shows free air in the retroperitoneal, intraperitoneal and posterior mediastinal spaces with pneumatosis intestinalis and gas bubble in the portal vein branches. Note the transplant kidney and atrophic native kidneys and right abdominal wall incisional hernia. Bilateral pleural effusion and ascites is evident too