Fatal colonic explosion during colonoscopic polypectomy

A patient is described who sustained the first reported colonic explosion during colonoscopic polypectomy. Mannitol solution was used for bowel preparation, and the colon was completely clean. During snare removal of a cecal polyp using high-frequency current a loud explosion occurred. In spite of emergency surgery with transfusion of 45 units of blood, uncontrollable hemorrhage persisted from multiple bleeding points, and the patient died. This occurrence seems to us to justify the routine use of carbon dioxide insufflation during polypectomy and the avoidance of mannitol for bowel preparation.