BACKGROUND: Increasing use of colonoscopy is making iatrogenic perforations more common. We herein present our experience with operative management of colonoscopic-related perforations. DESIGN: Retrospective review (1980-2006). SETTING: Tertiary referral center. PATIENTS: A total of 258 248 colonoscopies performed in patients, from which we identified 180 iatrogenic perforations (incidence, 0.07%). Of these, 165 perforations were managed operatively. RESULTS: Patients underwent primary repair (29%), resection with primary anastomosis (33%), or fecal diversion (38%). Patients presenting within 24 hours (78%) were more likely to have minimal peritoneal contamination (64 patients [50%] vs 6 [17%]; P = .01) and to undergo primary repair or resection with anastomosis (86 [67%] patients vs 13 [36%]; P < .01). Patients presenting after 24 hours (22%) were more likely to have feculent contamination (16 patients [44%] vs 4 [11%]; P = .02) and to receive an ostomy (23 patients [64%] vs 43 [33%]; P = .02). The sigmoid colon was the most frequent site of perforation, followed by the cecum (53% and 24%, respectively; P < .001); blunt or torque injury exceeded polypectomy and thermal injuries (55% vs 27% and 18%, respectively; P < .001). Patients with blunt injuries were more likely to receive a stoma than were those with polypectomy and thermal perforations (44 patients vs 9 and 9, respectively; P = .02), as were patients with feculent peritonitis compared with those with moderate and minimal soilage (28 patients [78%] vs 28 [42%] and 6 [10%] respectively; P = .002). Operative morbidity was 36%, with a mortality rate of 7%. Multivariate analysis indicated that blunt injuries, poor bowel preparation, corticosteroid use, and being younger than 67 years were risk factors for postoperative morbidity (P <or= .01); no factors correlated with death. CONCLUSIONS: Colonoscopic perforation occurs in fewer than 1 in 1000 patients and is associated with significant morbidity and mortality. Prompt diagnosis and operative therapy are critical in most cases.
BACKGROUND: Increasing use of colonoscopy is making iatrogenic perforations more common. We herein present our experience with operative management of colonoscopic-related perforations. DESIGN: Retrospective review (1980-2006). SETTING: Tertiary referral center. PATIENTS: A total of 258 248 colonoscopies performed in patients, from which we identified 180 iatrogenic perforations (incidence, 0.07%). Of these, 165 perforations were managed operatively. RESULTS:Patients underwent primary repair (29%), resection with primary anastomosis (33%), or fecal diversion (38%). Patients presenting within 24 hours (78%) were more likely to have minimal peritoneal contamination (64 patients [50%] vs 6 [17%]; P = .01) and to undergo primary repair or resection with anastomosis (86 [67%] patients vs 13 [36%]; P < .01). Patients presenting after 24 hours (22%) were more likely to have feculent contamination (16 patients [44%] vs 4 [11%]; P = .02) and to receive an ostomy (23 patients [64%] vs 43 [33%]; P = .02). The sigmoid colon was the most frequent site of perforation, followed by the cecum (53% and 24%, respectively; P < .001); blunt or torque injury exceeded polypectomy and thermal injuries (55% vs 27% and 18%, respectively; P < .001). Patients with blunt injuries were more likely to receive a stoma than were those with polypectomy and thermal perforations (44 patients vs 9 and 9, respectively; P = .02), as were patients with feculent peritonitis compared with those with moderate and minimal soilage (28 patients [78%] vs 28 [42%] and 6 [10%] respectively; P = .002). Operative morbidity was 36%, with a mortality rate of 7%. Multivariate analysis indicated that blunt injuries, poor bowel preparation, corticosteroid use, and being younger than 67 years were risk factors for postoperative morbidity (P <or= .01); no factors correlated with death. CONCLUSIONS: Colonoscopic perforation occurs in fewer than 1 in 1000 patients and is associated with significant morbidity and mortality. Prompt diagnosis and operative therapy are critical in most cases.
Authors: Alexander Fritzkarl Hagel; Andreas Naegel; Annette Simone Lindner; Hermann Kessler; Klaus Matzel; Wolfgang Dauth; Markus Friedrich Neurath; Martin Raithel Journal: J Gastrointest Surg Date: 2012-08-18 Impact factor: 3.452
Authors: Ashwin S Kamath; Corey W Iqbal; Michael G Sarr; Daniel C Cullinane; Scott P Zietlow; David R Farley; Mark D Sawyer Journal: J Gastrointest Surg Date: 2009-10-15 Impact factor: 3.452