[Management of colonoscopic perforations of large bowel]

Perforation of large bowel during elective colonoscopy is rare but serious life threatening complication. Early diagnosis of perforation during or soon after colonoscopy shortens time of peritoneal contamination and allows to get good results of surgical treatment. The aims of this study were to determine the incidence of perforation due to colonoscopy in our hospital and to assess methods and results of surgical treatment.

We reviewed our prospectively collected data of 957 patients operated on because of colorectal diseases in the period from January 2003 to December 2010. Data of 16 patients (1.7%) aged from 22 to 89 years of life (average age 67.5 years) operated on because of colonoscopic perforations were analysed.

Perforation of large bowel occurred in 9 patients (0.13%) of 6570 persons colonoscopised in our hospital. All 16 patients were operated on in the period of 0.5-32 hours since colonoscopy was performed. Simple suture of the laesion was the most common procedure performed in 12 patients (4 of them had proximal colostomies performed as well). Postoperative complications occurred in 3 patients (18.7%). Nobody died--mortality 0. Average time of hospital postoperative stay was 8.3 days.

Colonoscopic perforation of large bowel requires surgical treatment. Choice of repair method depends on diameter of perforation, time since onset to operation passed, spread and degree of peritoneal contamination and general patient's condition.