Management of colonic perforation after colonoscopy

Carpio, Gregorio; Albu, Eugene; Gumbs, Milton A.; Gerst, Paul H.

doi:10.1007/bf02554186

Cited by 69 publications

(37 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Perforations during therapeutic colonoscopy occur as a result of similar mechanisms, as well as from thermal or electrical injury, as in two cases in the present study [11,12] . The most frequent site of perforation was the sigmoid colon, as in other studies [10,13,18,23,24] . This may be explained by its anatomical characteristics of frequent redundancy or narrowing from diverticular disease or adhesions after previous pelvic operations [25] .…”

Section: Discussionsupporting

confidence: 68%

Incidence and management of colonoscopic perforations: 8 years’ experience

Tulchinsky¹

2006

WJG

View full text Add to dashboard Cite

AIM:To review the experience of a major medical teaching center with diagnostic and therapeutic c o l o n o s c o p i e s a n d t o a s s e s s t h e i n c i d e n c e a n d management of related colonic perforations. METHODS:All colonoscopies performed between January 1994 and December 2001 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from the departmental computerized database. The medical records of the patients with post procedural colonic perforation were reviewed. RESULTS:A total of 12 067 colonoscopies were performed during the 8 years of the study. Seven colonoscopic perforations (4 females, 3 males) were diagnosed (0.058%). Five occurred during diagnostic and two during therapeutic colonoscopy. Six were suspected during or immediately after colonoscopy. All except one had signs of diffuse tenderness and underwent immediate operation with primary repair done in 4 patients. No deaths were reported. CONCLUSION:Perforation rate during colonoscopy is low. Nevertheless, it is a serious complication and its early recognition and treatment are essential to optimize outcome. In patients with diffuse peritonitis early operative intervention makes primary repair a safe option.

show abstract

Section: Discussionsupporting

confidence: 68%

Incidence and management of colonoscopic perforations: 8 years’ experience

Tulchinsky¹

2006

WJG

View full text Add to dashboard Cite

show abstract

“…We started conservative treatment in only one patient, then changed to surgical treatment after 2 days because of unsatisfactory recovery [3,5,10,11,21]. Delaying surgery in some situations may lead to irretrievable situations [10].…”

Section: Discussionmentioning

confidence: 99%

“…Colonic 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].…”

Section: Abstract: Colon Perforation -Colonoscopycomplication -Endosmentioning

confidence: 99%

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

“…La ausencia de gas extracolónico no excluye el diagnós-tico de perforación (17) y la sola presencia del mismo no es suficiente justificación para realizar cirugía (11,16,25,31,32). El manejo terapéutico de estos pacientes es controvertido y el fracaso del tratamiento conservador que obliga a una posterior laparotomía es en algunas series igual o superior al 50% de los casos (2,15).…”

Section: Discussionunclassified

“…El tipo de cirugía dependerá del tamaño de la lesión, grado de contaminación, patología colónica asociada y estado general del paciente (8,10,11) por lo que se incluyen dentro de las opciones quirúrgicas la sutura de la perforación, resección y anastomosis primaria con o sin estoma de protección y resección intestinal y estoma en aquellos pacientes con una contaminación fecal extensa, múltiples comorbilidades o inestabilidad hemodinámica (2,4,(16)(17)(18)32).…”

Section: Discussionunclassified

Perforación tras colonoscopia: experiencia en 16 años

Martínez

Poblador

Raposo

et al. 2007

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

INTRODUCCIÓNLa colonoscopia es un procedimiento habitual utilizado en el diagnóstico, tratamiento y seguimiento de las enfermedades del colon. La perforación tras colonoscopia REV ESP ENFERM DIG (Madrid) Vol. 99. N.°10, pp. 588-592, 2007 Recibido: 30-03-07. Aceptado: 10-07-07. Correspondencia RESUMENObjetivo: el propósito de este estudio retrospectivo fue conocer la incidencia de perforaciones de colon por colonoscopia diagnóstica y terapéutica y valorar el manejo de las mismas en nuestro medio.Pacientes y método: se revisaron las perforaciones por colonoscopias realizadas en nuestro hospital entre enero de 1991 y diciembre de 2006. Se analizaron la finalidad del procedimiento, el mecanismo de la lesión, su presentación clínica y radiológica, el retraso diagnóstico, el estado general de los pacientes, el manejo terapéutico y sus resultados.Resultados: en el periodo de estudio hubo 15 perforaciones (0,09%) de un total de 16.285 colonoscopias realizadas (9 varones, 6 mujeres). Nueve ocurrieron tras colonoscopias diagnósticas y 6 terapéuticas. El 60% de las perforaciones fueron advertidas por el endoscopista durante el procedimiento (en el 88,6% de las diagnósticas y en el 16,6% de las terapéuticas). En el 73,7% de los casos el dolor con distensión abdominal fue el síntoma más frecuente y en 11 pacientes con pruebas de imagen se apreció gas extraluminal en el 100% de los casos. El retraso diagnóstico (> 24 horas) ocurrió en el 40% de los pacientes (rango: 1-6 días). Fueron intervenidos 12 pacientes (80%) de los que 4 eran ASA II y 8 ASA III/IV. La morbilidad postoperatoria fue del 44,44% y la mortalidad del 25%. La evolución de los pacientes tratados conservadoramente fue satisfactoria.Conclusión: la perforación de colon por colonoscopia es una complicación rara de consecuencias graves e incluso letales. El tratamiento conservador puede realizarse en casos seleccionados y bajo un control clínico estricto. El tipo de cirugía va a depender de la localización, tamaño de la lesión, patología colónica concomitante y grado de contaminación fecal. La mortalidad parece estar más relacionada con el estado general del paciente que con la propia técnica quirúrgica realizada.Palabras clave: Perforación colon. Colonoscopia. Complicaciones colonoscopia. ABSTRACTObjective: the aim of this retrospective study was to evaluate the incidence of colon perforations from diagnostic and therapeutic colonoscopies, and to assess their management in our hospital.Patients and method: perforations resulting from colonoscopy in our hospital were reviewed for the period January, 1991 to December, 2006. The study analyzed: purpose of procedure, lesion mechanisms, clinical and radiological presentations, delays in diagnosis, patient status, therapeutic handling, and outcome.Result: fifteen perforations (0.09%) (9 males and 6 females) out of a total of 16,285 colonoscopies carried out were seen to have taken place during the study period. Nine of these occurred after diagnostic colonoscopies, and 6 occurred after therapeutic endoscopies. Aroun...

show abstract

Management of colonic perforation after colonoscopy

Cited by 69 publications

References 9 publications

Incidence and management of colonoscopic perforations: 8 years’ experience

Incidence and management of colonoscopic perforations: 8 years’ experience

Colonoscopic perforations: a review of 30,366 patients

Perforación tras colonoscopia: experiencia en 16 años

Contact Info

Product

Resources

About