[Surgical management of perforations during colonoscopy]

Colonoscopy is an effective both diagnostic and therapeutic method. Despite its wide use, however, colonoscopy may be associated with complications occurrence, of which the most serious is bleeding and perforation. Iatrogenic perforation can lead to the peritonitis with high morbidity and mortality. The relative frequency of perforation in diagnostic colonoscopies is 0.03-0.8%, for therapeutic colonoscopy 0.15-3%. The most iatrogenic perforations are located on sigmoid colon.

The endoscopic unit of University Hospital Ostrava performed a total of 7800 colonoscopy in the period between 1st January 2006 to 31st December 2010. In 8 patients (0.1%) occurred perforation of the colorectum. In all patients, this complication arose during diagnostic colonoscopy and was treated by surgery. Six patients (75%) were operated on within 24 hours from the performance of colonoscopy, 2 patients (25%) were operated after more than 24 hours. In 5 patients (62.5%) the left colon including rectum was perforated, in 3 patients (37.5%) perforation occurred in right colon.

Postoperative complications occurred in 7 patients, postoperative morbidity was 87.5%. In 1 patient (12.5%) surgical revision was necessary. 2 patients died within 30 days after surgery, mortality was 25%.

Iatrogenic perforation of the colorectum is one of the most serious complications during colonoscopy. Early and optimal treatment is crucial for the subsequent reduction of serious complications and mortality.