Surgical Management of Colonoscopic Perforations
Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR
Arch Surg. 2008;143:701-706; discussion 706-707

This report summarizes the experience of a single institution in the management of colon perforation following colonoscopy over a period of about 25 years. During this time, iatrogenic perforation occurred in 180 of 258,000 procedures, yielding a rate of 0.07%. Approximately one third of patients underwent either a resection, primary closure of the perforation, or diversion with a colostomy. In the majority of patients (78%), the perforation was diagnosed within 24 hours, allowing for primary repair with or without excision of the perforated area. The overall mortality rate was 7%. Most perforations (53%) occurred in the rectosigmoid region, with the cecum being the second most frequent site.

In 2008, an estimated 150,000 new patients will be diagnosed with colorectal cancer in the United States. Many will undergo colonoscopy as part of their diagnostic work-up; fortunately, perforation after colonoscopy is a rare event with a frequency of < 1%. When perforation does happen, prompt recognition leads to a better outcome. Most of the perforations in this report were associated with blunt injury, rather than thermal injury or polyp excision. The study authors suggested that prior abdominal surgery with resultant adhesions may be a risk factor because it was observed in 61% of the patients who sustained a perforation.

Abstract