Colonoscopic perforations: a review of 30,366 patients

Abstract

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...

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