Clin Endosc.  2016 May;49(3):282-288. 10.5946/ce.2015.046.

Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation

• Shin DK
• Shin SY
• Park CY
• Jin SM
• Cho YH
• Kim WH
• Kwon CI
• Ko KH
• Hahm KB
• Park PW
• Kim JW
• Hong SP

• KMID: 2165023
• DOI: http://doi.org/10.5946/ce.2015.046

Abstract

BACKGROUND/AIMS
Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations.
METHODS
We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea.
RESULTS
A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively.
CONCLUSIONS
Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

Keyword

Colonoscopy; Colonoscopic perforation; Laparoscopic surgery

MeSH Terms

Colonoscopy
Delayed Diagnosis
Humans
Korea
Laparoscopy
Laparotomy
Medical Records
Methods*
Mortality
Peritonitis
Retrospective Studies

Figure

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  Fig. 1. Elapsed time from perforation to surgery according to the awareness of the perforation. (A) Elapsed time in patients with an immediate diagnosis of perforation. (B) Elapsed time in patients with a delayed diagnosis of perforation. There was no statistical difference in the elapsed time between laparotomy and laparoscopy.

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  Fig. 2. Flow chart for the management of iatrogenic colonoscopic perforation. Colonoscopic perforations could be found during or after procedures. This figure shows processes and clinical outcomes of each management for colonoscopic perforations.

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