Clinical presentation and management of iatrogenic colon perforations

Gedebou, Tewodros M.; Wong, Randy; Rappaport, William D.; Jaffe, Philip E.; Kahsai, Daniel; Hunter, Glenn C.

doi:10.1016/s0002-9610(96)00236-x

Cited by 113 publications

(68 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study found the perforation risk for colonoscopic procedures to be four times higher, exceeding the relative risk ratio of 2 described in previous reports [8]. Several studies have shown a difference in perforation rates between diagnostic and therapeutic procedures [4,9].…”

Section: Discussioncontrasting

confidence: 67%

Colonoscopic perforations: a review of 30,366 patients

et al. 2007

View full text Add to dashboard Cite

Background: Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of procedures could pose relevant health problems. Recognizing risk factors and optimizing treatment may reduce perforation incidence and the probability of (severe) complications. This study aimed to determine perforation frequency and the management of endoscopic colonoscopic perforation. Methods: A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoido/colonoscopy between 1990 and 2005. The patientsÕ demographic data, endoscopic procedural information, perforation location, therapy, and outcome were recorded. Results: In the 16-year period, 30,366 endoscopic colonic procedures were performed. In total, 35 colonic perforations occured (0.12%). All the patients underwent a laparotomy: for primary repair in 18 cases (56%), for resection with anastomosis in 8 cases (25%), and for resection without anastomosis in 6 cases (19%). In three patients (8.6%), no perforation was found. The postoperative course was uncomplicated in 21 cases (60%) and complicated in 14 cases (40%), including mortality for 3 patients (8.6% resulting from perforations and 0.01% resulting from total endoscopic colon procedures). The relative risk ratio of colonoscopic and sigmoidoscopic procedures for perforations was 4. Therapeutic procedures show a delay in presentation and diagnosis compared with diagnostic procedures. Of the 35 perforations, 26 (74%) occurred in the sigmoid colon. Conclusion: Iatrogenic colonic perforation is a serious but rare complication of colonoscopy. A perforation risk of 0.12% was found. The perforation risk was higher for colonoscopic procedures than for sigmoidoscopic procedures. The sigmoid colon is the area at greatest risk for perforation. Immediate operative management, preferably primary repair and sometimes resection, appears to be a good strategy for most patients. Key words: Colon perforation -ColonoscopyComplication -Endoscopy -IatrogenicColonic perforation resulting from colonoscopic and sigmoidoscopic procedures is a rare but serious complication with high rates of morbidity and mortality [1,3,6,7,12]. The frequency of perforations after colonoscopy is estimated to be 0.03% to 0.8% for diagnostic colonoscopy and 0.15% to 3% for therapeutic colonoscopy [22]. With increasing numbers of colonoscopies being performed for screening purposes, this small possibility of perforations still may cause a high number of clinical problems. The optimal treatment for perforations, whether conservative or operative, still is unclear because no randomized trial has ever been conducted.Recent studies are acquiring evidence for laparoscopic and endoluminal repair using clips for perforation closure [15-17, 19, 22]. Knowing risk factors, recognizing early signs of perforation, and giving early and optimal treatment may reduce the probability of (severe) complications and death from iatrogenic colon perforations. In this report, we re...

show abstract

Section: Discussioncontrasting

confidence: 67%

Colonoscopic perforations: a review of 30,366 patients

et al. 2007

View full text Add to dashboard Cite

show abstract

“…When this procedure is performed by an experienced endoscopist, the risk of bowel perforation should not be higher than with diagnostic colonoscopy (2/1000) [25]. In our case, colonoscopy-assisted reposition was successful even at a rather late gestation of 20 weeks.…”

Section: Discussionmentioning

confidence: 54%

Recurrent incarceration and/or sacculation of the gravid uterus: A review

Dierickx¹,

Mesens²,

Holsbeke³

et al. 2009

The Journal of Maternal-Fetal & Neonatal Medicine

View full text Add to dashboard Cite

Retroverted uterine incarceration with sacculation of the anterior wall is reported to occur approximately in 1/3000 pregnancies. A literature search identified only 1 case report of incarceration of an anteflexed gravid uterus and 6 reported cases of recurrent incarceration and/or sacculation. We present a case of an incarceration of an anteflexed uterus in the first pregnancy, followed by a retroflexed incarceration in the second pregnancy. From this, a review is presented on recurrent uterine incarceration and/or sacculation.

show abstract

“…Barotrauma is another important mechanism; it results from excessive gas insufflation leading to linear tear or full-thickness perforation of the serosa. Perforations due to barotrauma may occur in the right colon due to its width (18,19). They can occur not only in the cecum but also in high-pressure zones such as angulations in the sigmoid colon or herniated loops that enter into the inguinal and ventral sacs (20).…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: Single center experience and review of the literature

Çolak¹,

Gürbulak²,

Bektaş³

et al. 2017

Turk J Surg

View full text Add to dashboard Cite

Colonoscopic perforations: Single center experience and review of the literature INTRODUCTION Colonoscopy is accepted as the gold standard imaging modality for the diagnosis of colon and distal ileum diseases. It aids the detection of smaller lesions and tissue sampling and also functions as a therapeutic procedure for intestinal diseases. Similar to other invasive procedures, colonoscopy has been associated with various complications; among these, perforation is the most important. Iatrogenic colonic perforation has high rates of mortality and morbidity. It is mainly divided into two categories: diagnostic and therapeutic (1, 2). Management includes both medical and surgical approaches. However, the best approach for treatment depends on various factors, such as the patient's general condition, age, comorbidities, and, most importantly, the time between the onset and diagnosis of perforation. In this study, we aimed to evaluate the incidence of perforation in a large colonoscopy series, discuss patient management strategies, and analyze the clinical consequences of iatrogenic colonic perforation. MATERIAL AND METHODSBetween January 2005 and May 2015, a total of 31,655 lower GIS endoscopies were performed at our center. Patients with iatrogenic colonic perforations were investigated retrospectively. All procedures were conducted under sedoanalgesia. The procedures were performed by 27 endoscopists, including 24 general surgeons and 3 gastroenterology specialists. The experience of the endoscopists varied between 2 and 15 years.We analyzed the demographic characteristics of the patients, the type of procedure (therapeutic or diagnostic), indications for colonoscopy and associated colonic disease, location and detection time of perforation, management strategy (operative or nonoperative), and complications.The perforations were detected either during colonoscopy by observing a visible defect in the colonic wall (mesenteric or antimesenteric side) or after the procedure by detecting free intra-abdominal air upon radiological examination. Patients who complained of abdominal pain or distention following 195Objective: Iatrogenic colonic perforation is a well-known complication that can increase mortality and morbidity in patients undergoing colonoscopy. Closer follow-up and a well-planned treatment strategy are required when perforation arises as a complication. The aims of this study are to (1) report our experience with a large colonoscopy series; (2) evaluate the underlying mechanisms of iatrogenic colonic perforation; (3) discuss the ideal period between onset and treatment; and (4) review the current literature regarding the management of iatrogenic colonic perforations. Material and Methods:Patients who underwent colonoscopy between January 2005 and May 2015 at a single center were reviewed retrospectively. Procedures during which colonic perforations occurred were documented and analyzed.Results: Between January 2005 and May 2015, 31,655 patients underwent colonoscopy and 5,214 patients underwent recto-sigmoi...

show abstract

Clinical presentation and management of iatrogenic colon perforations

Cited by 113 publications

References 12 publications

Colonoscopic perforations: a review of 30,366 patients

Colonoscopic perforations: a review of 30,366 patients

Recurrent incarceration and/or sacculation of the gravid uterus: A review

Colonoscopic perforations: Single center experience and review of the literature

Contact Info

Product

Resources

About