Propofol-induced anaphylaxis with severe angioedema during colonoscopy: a case report

Propofol is widely used for procedural sedation and anesthesia due to its rapid onset and recovery. Although regarded as safe, it can rarely provoke severe allergic reactions, including anaphylaxis. Because these events are infrequent, recognition may be delayed, particularly when clinical features are atypical. We described a case of propofol-induced anaphylaxis during outpatient colonoscopy in a 66-year-old man with no known allergies. The patient developed sudden desaturation, hypotension, and progressive facial and cervical angioedema, initially misinterpreted as bowel perforation due to associated abdominal distention. Multiple intubation attempts failed, necessitating an emergent tracheostomy. This case emphasizes the need for early suspicion of anaphylaxis in unexplained perioperative collapse, prompt administration of epinephrine, airway preparedness, and post-event allergy evaluation to confirm the diagnosis and prevent re-exposure.