Diverticular rupture during colonoscopy. Fact or fancy?

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Endoscopy

Background:

• Colonic diverticula are often considered weak points in the bowel wall.
• There is a prevailing assumption that these weak points may rupture during colonoscopy.

Purpose of the Study:

• To investigate whether uncomplicated colonic diverticula are prone to rupture during colonoscopy.
• To determine the pressure required to rupture diverticula and compare it with pressures generated during colonoscopy.

Main Methods:

• Cadaveric sigmoid colon segments with diverticula were insufflated to determine rupture pressure.
• Intraluminal sigmoid pressures were measured manometrically in patients with and without diverticula during routine colonoscopy.

Main Results:

• The mean pressure for serosal tear was 202 ± 15 mm Hg and for mucosal rupture was 226 ± 14 mm Hg.
• No diverticular blowouts were observed in the cadaveric study.
• Intraluminal pressures during colonoscopy were significantly lower than those required for rupture.
• Sigmoid pressures were similar in patients with and without diverticula.

Conclusions:

• Diverticula blowout is unlikely to be the cause of most colonic perforations during colonoscopy.
• Instrumental trauma is the most common cause of sigmoid colon perforations during colonoscopy.
• Excessive air insufflation can cause serosal laceration or mucosal rupture, but diverticular blowout is rare outside of acute diverticulitis.