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Perforations from colonoscopy during diagnosis and treatment of polyps
Insights
Colonoscopy and polypectomy can cause large bowel perforations, with incidences of 0.6% and 0.7% respectively. Forceful scope insertion and electrocoagulation are key causes, requiring surgical intervention.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Endoscopy
Background:
- Colonoscopy is a vital diagnostic and therapeutic tool for large bowel pathologies.
- Polyp removal (polypectomy) is a common procedure performed during colonoscopy.
- Gastrointestinal perforations are a rare but serious complication of endoscopic procedures.
Purpose of the Study:
- To investigate the incidence and causes of large bowel perforations following colonoscopy and polypectomy.
- To analyze the clinical presentation and management outcomes of these perforations.
Main Methods:
- Retrospective analysis of 11 cases of large bowel perforation over a 10-year period.
- Data collected included colonoscopy details, perforation characteristics, and treatment strategies.
Main Results:
- The incidence of perforation was 0.6% for diagnostic colonoscopy and 0.7% for polypectomy.
- Most perforations occurred in the sigmoid colon, linked to forceful scope insertion and electrocoagulation.
- Surgical intervention (laparotomy) and antibiotics were the primary treatments, with most patients operated on promptly.
Conclusions:
- Colonoscopic perforations, though infrequent, necessitate prompt diagnosis and surgical management.
- Technique optimization, particularly regarding scope insertion and electrocoagulation, may reduce perforation risk.
Abstract:
Within a department specialized in surgical gastroenterology 11 perforations of the large bowel occurred over a 10 year period as complication of diagnosis and treatment of polyps by colonoscopy. The incidence by diagnostic colonoscopy was 0.6% (95% confidence interval 0.2-1.3%) and by polypectomy 0.7% (95% confidence interval 0.2-1.8%). Nine of the perforations were located in the sigmoid colon; one occurred retroperitonally in the descending colon. The lesions were from 1-8 cm long and were located in normal bowelsegments. The most important cause of perforation was forceful introduction of the scope and the use of electrocoagulation. The patients were treated by laparotomy and antibiotics. In six cases the operation was initiated within one hour after the perforation had occurred, the remaining 5 were operated on when they developed symptoms 1/2-3 days after the colonoscopy. One patient, a 84-year-old man, died of acute myocardial infarction 4 weeks after the operation.