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Management of colonoscopic perforations
D R Farley1, M P Bannon, S P Zietlow
1Division of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clinic Proceedings
|August 1, 1997
Summary
Colonoscopic perforation is a rare complication, but increased colonoscopy use leads to more cases. Prompt surgery is usually best, though non-operative management may suit select patients without peritoneal irritation.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Medical Device Safety
Background:
- Colonoscopy is a vital diagnostic and therapeutic tool.
- Iatrogenic colon perforation is a known, albeit rare, complication.
- The increasing volume of colonoscopies necessitates understanding perforation management.
Purpose of the Study:
- To analyze surgical management strategies for colonoscopic perforations.
- To identify factors influencing patient outcomes after colon perforation.
- To refine patient care protocols for iatrogenic colon injuries.
Main Methods:
- Retrospective analysis of medical records from 1980-1995.
- Inclusion of 45 patients with colonoscopic perforations.
- Analysis of surgical morbidity and mortality rates.
Main Results:
- 43 perforations occurred in 57,028 colonoscopies (0.075%).
- Emergency laparotomy was performed in 93% of cases.
- Postoperative complications were linked to older age, larger perforations, and prior hospitalization; no deaths occurred.
Conclusions:
- Despite low risk, increased colonoscopy use results in more perforations.
- Prompt surgical intervention is the optimal strategy for most patients.
- Non-operative management is suitable for carefully selected patients without peritoneal irritation.