[Diagnosis and management of colon perforation after colonoscopy]

Colon perforation is an uncommon but feared complication of colonoscopy. The treatment is usually surgical but occasionally it does not require an operation.

To report our experience in the diagnosis and management of colon perforation after colonoscopy.

Retrospective review of the database of 11,720 colonoscopies. The medical records of those patients that had a perforation were reviewed.

Twelve perforations in patients aged 26 to 92 years (six women), were identified with a global perforation rate of 0.1%. Five occurred during diagnostic and seven during therapeutic procedures. All perforations were confirmed by a plain X ray or CT scan of the abdomen. Four patients, without signs of initial diffuse peritoneal irritation, were medically treated. One of these, finally required surgery. Among operated patients, a primary suture was done in five, a primary excision without colostomy in three and a Hartmann procedure due to a severe peritoneal contamination in one. No patient died.

There is a higher risk of colon perforation during therapeutic colonoscopies. Selected cases may be safely treated without surgery.