Prompt Management Is Most Important for Colonic Perforation After Colonoscopy

Abstract

PurposeThe incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation.MethodsFrom March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy.ResultsA total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly.ConclusionAlthough a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

“…These findings are similar to previous studies, with Iqbal et al identifying patients presenting at >24 h were more likely to have gross contamination and require faecal diversion . Time to diagnosis thus influences the operative management, as well as hospital LOS …”

Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats

“…Perforation was diagnosed in a third dog by thoracic radiography that included the cranial abdomen. Ultrasonography In several studies, morbidity rate increased in people when perforations were diagnosed >24 hours after endoscopy, 16,31,34 but other studies found no association between the time to detection and patient prognosis. 14,17 The low number of cases in our series limits the ability to determine risk factors, but morbidity was higher in animals with delayed diagnoses.…”

Colonoscopic Perforations

“…Such patients need prompt evaluation for a colon perforation. 20 Abdominal plain films are diagnostic in most cases if they depict extraluminal free air. Computed tomography scans may be needed in patients with negative or equivocal radiographs.…”

“…Early diagnosis and appropriate management mitigate the morbidity and the mortality associated with colonoscopic perforation. 20 However, the lack of large prospective randomized trials and specific guidelines makes it difficult to define optimal management of colonoscopic perforations. 23 In stable patients, treatment options range from nonoperative management to laparotomy with colon resection.…”