Complications of fiberoptic Endoscopy. II. Colonoscopy

Fiberoptic colonoscopy is being used increasingly for endoscopic visualization of the large intestine, particularly in the electrocautery removal of polypoid lesions. Complications may include bleeding, mesosigmoid hematoma, splenic avulsion, and impaction of the instrument, but the most common is perforation of the colon, which occurs in 0.4-1.9% of colonoscopic examinations. Radiological evaluation plays a critical role. Free intraperitoneal rupture may be clinically overlooked in an aged or infirm patient. Extraperitoneal perforation often results in delayed signs and symptoms. The demonstration of extraluminal gas documents perforation. Recent roentgen-anatomical studies of the characteristic distribution of extraperitoneal gas may permit precise localization of the site of colonic perforation on plain films.