Management of latrogenic perforation after gastrointestinal endoscopy

Gastrointestinal perforation during endoscopy is a rare but severe complication. Most instances occur during colonoscopy.

We retrospectively evaluated the cases of 23 patients with iatrogenic perforation (13 women, 10 men; mean age = 71 years [range, 49-89]). We identified 6 esogastric perforations, 2 endoscopic retrograde cholangiopancreatography (ERCP)-related perforations, and 15 colonic perforations. Demographics, type and aim of endoscopy, mechanism of perforation, delay of treatment, operative procedure, postoperative hospital stay, and mortality rate were analyzed.

Three perforations occurred during diagnostic gastroscopy and 3 during therapeutic gastroscopy. ERCP-related perforations occurred during therapeutic procedures. Nine colonic perforations occurred during interventional colonoscopy. ERCP-related perforations always required laparotomy. For esogastric perforations, surgical treatment usually required laparotomy; only two patients (33%) could be managed by laparoscopy. In contrast, colon perforations could be managed by a laparoscopic approach (suturing and drainage or by laparoscopic resection) in 86.6% of cases. Overall mortality was 13% and occurred exclusively after esogastric perforation.

Most gastrointestinal perforations occurred during therapeutic colonoscopy; these perforations could be treated by laparoscopy in most cases. Esogastric perforations and perforations after ERCP are rare and must be treated on a case-by-case basis; in most cases, laparotomy is required.