Treatment of colon endoscopic perforations

We describe the treatment of 9 patients who underwent endoscopic perforation of the large bowel. All perforations occurred in patients with colonic diverticulosis or during polypectomy. The choice between conservative or surgical management essentially depends on clinical criteria. Conservative treatment, clinical observation, broad spectrum antibiotics and parenteral diet, is recommended for patient in good general condition and without any sign of peritoneal irritation. Free intraperitoneal gas on X-ray is not an indication for laparotomy. On the other hand, the development of peritonism or clinical deterioration under medical treatment requires a surgical management. Primary suture of the perforation can be performed if the colon was well cleansed for colonoscopy, if the perforation is small and if there is no suspicion of underlying carcinoma. In the other cases, resection including the perforation must be recommended.