Clin Endosc.  2020 Jan;53(1):29-36. 10.5946/ce.2019.061.

Endoscopic Management of Iatrogenic Colon Perforation

• Jung Y

• KMID: 2500902
• DOI: http://doi.org/10.5946/ce.2019.061

Abstract

Colon perforations are difficult to resolve because they occur unexpectedly and infrequently. If the clinician is unprepared or lacks training in dealing with perforations, the clinical prognosis will be affected, which can lead to legal issues. We describe here the proper approach to the management of perforations, including deciding on endoscopic or surgical treatment, selection of endoscopic devices, endoscopic closure procedures, and general management of perforations that occur during diagnostic or therapeutic colonoscopy.

Keyword

Colon; Perforation

Figure

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  Fig. 1. (A) A 7-mm sessile polyp was resected using a snare. (B) A perforation was observed at the site of polypectomy. (C) Mirror target sign of the specimen.

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  Fig. 2. (A) A 6-mm penetrating perforation occurred in the sigmoid colon during a diagnostic colonoscopy. (B) Successful closure of the perforation with hemoclips.

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  Fig. 3. (A) A 2-cm nodular mixed-type lateral spreading tumor in the rectosigmoid colon. (B) A 4-mm perforation occurred during an endoscopic submucosal dissection (ESD). (C) After further dissection of the submucosal layer, hemoclips were applied to the perforation and the circumferential incision was completed. (D) The lesion was removed using the hybrid ESD technique.

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  Fig. 4. (A) One of the lateral edges of the defect was grasped using one arm of the twin grasper. (B) The other edge of the defect was grasped using the second arm of the twin grasper. (C) The re-apposed tissue was pulled into the over-the-scope clip (OTSC) cap. (D) The OTSC was released by turning a wheel on the shaft of the endoscope.

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  Fig. 5. (A) An approximately 7-mm perforation in the intestine. (B) The surrounding perforated tissues and the perforation were suctioned sufficiently into the banding cap until a “pink or red out sign” was observed. (C) The iatrogenic perforation was successfully closed using the band-ligation method (Adapted from Jung [19]).

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  Fig. 6. (A) The endoloop was placed around the perforated tissue through one channel of a double-channel endoscope. (B) Several hemoclips were applied through the other channel to fix the endoloop and surrounding perforated tissues. (C) The endoloop was tightened to close or reduce the perforation. (D) Complete closure of the perforation was achieved (Adapted from Jung [19]).

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