Conservative Treatment of Colonoscopic Perforations

Cho, Yong Keun; Nam, Sang Woo; Kim, Hyun Chul; Ko, Eun Young; Kim, Yang Ho; Park, Seung Min; Lee, Yong Ung; Cho, Jin Woong

Abstract

BACKGROUND/AIMS: Colonoscopic perforation can be treated by both operative or non-operative methods. Non-operative management, and especially conservative management, may be appropriate for selected individuals. We wanted to verify the usefulness of performing conservative management for treating colonoscopic perforations.
METHODS
We reviewed the medical records of the colonoscopic perforation cases that occurred in the recent 5 yrs. 11 cases of perforation occurred from among 8,536 colonoscopic procedures.
RESULTS
Ten cases occurred from a therapeutic procedure (five from polypectomy and another five occurred from an endoscopic (submucosal dissection) and one case occurred from a diagnostic procedure. The perforation sites were the ascending colon (three cases), transverse colon (two cases), descending colon (one case), sigmoid colon (two cases), and rectum (three cases). There were five intraperitoneal perforations and five retroperitoneal perforations. All the cases were detected within 12 hours and all the cases had received good bowel preparation. 10 cases were managed conservatively (nothing by mouth, broad spectrum antibiotics and, Levin tube suction). One case was managed by an operative procedure due to the large size of the defect and the patient's wish. All the patients recovered without complications. The mean hospital stay was 9.5 days.
CONCLUSIONS
Colonoscopic perforation can managed conservatively in selected cases, such as for those cases that will undergo post-therapeutic colonoscopy and those cases that have undergone good bowel preparation.