J Korean Soc Coloproctol.
2007 Oct;23(5):287-291.
Surgical Management of Colonoscopic Perforations
- Affiliations
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- 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. jgpark@plaza.snu.ac.kr
- 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Abstract
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PURPOSE: The purpose of this study is to evaluate the clinical features that necessitate a temporary stoma for the treatment of colonoscopic perforations.
RESULTS
Between January 2000 and July 2006, 30 patients were treated for colonoscopic perforation. Based on the perforation sites, we classified these patients into the following groups: proximal colon, sigmoid colon, and rectum; we then reviewed clinical data, including the time to operation and management.
RESULTS
Seventeen patients had a perforation during the diagnostic colonoscopy. Of these patients, 14 patients had sigmoid colon perforation. Six underwent an operation within 10 hours after perforation. Of these six, four were managed by primary repair or resection with anastomosis, one sigmoid colon cancer patient by anterior resection, and one rectal cancer patient by low anterior resection with diverting ileostomy. Eight patients underwent more than 12 hours after perforation. Of these eight, three were managed by resection with anastomosis and diverting ileostomy and five by resection with end colostomy. Thirteen patients had a perforation during the therapeutic colonoscopy. Of these patients, 10 patients had a proximal colon perforation. Of these 10, 3 without fever or peritonitis symptom were managed by conservative management, 6 by primary repair or resection with anastomosis, and 1 transverse colon cancer patient by right hemicolectomy. Three patients had sigmoid colon perforation. Of these three, one was managed by primary repair, one by resection with anastomosis, and one sigmoid colon cancer patient by anterior resection.
CONCLUSIONS
The mechanism of perforation, the site of the perforation, and the time to operation are associated with intraperitoneal contamination and have an influence on surgical treatment.
