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Management of colonoscopic perforations.
Mayo Clin Proc. 1997 Aug; 72(8):729-33.MC

Abstract

OBJECTIVE

To document our evolving surgical management of colonoscopic perforation and examine factors crucial to the improvement of patient care.

DESIGN

We conducted a computer-based retrospective analysis of medical records (1980 through 1995).

MATERIAL AND METHODS

Among 57,028 colonoscopic procedures performed, 43 patients (0.075%, or 1 perforation in 1,333 procedures) had a colonic perforation. Two additional patients were treated after colonoscopy performed elsewhere. The outcomes analyzed included surgical morbidity and mortality.

RESULTS

Twenty-six women and 19 men who ranged in age from 28 to 85 years (median, 69) were treated for colonic perforation. More than 80% of perforations occurred during the latter half of the study period because of the increased volume of colonoscopic procedures (8 perforations among 12,581 examinations from 1980 through 1987 versus 35 perforations among 44,447 colonoscopies from 1988 through 1995). Emergency laparotomy was performed in 42 patients (93%). Perforations occurred throughout the colon: right side = 10; transverse = 9; and left side = 23. Three patients without evidence of peritoneal irritation fared well with nonoperative management. Most patients underwent primary repair or limited resection in conjunction with end-to-end anastomosis. In 14 patients (33%), an ostomy was created. One patient underwent laparotomy without further treatment. Intra-abdominal contamination ranged from none (31%) to local soiling (48%) to diffusely feculent (21%). Postoperative complications occurred in 12 patients and were associated with older age (P = 0.01), large perforations (P = 0.03), and prior hospitalization (P = 0.04). No postoperative deaths occurred.

CONCLUSION

Despite a consistently low risk of colonic perforation, the increasing use of colonoscopy in our practice has resulted in an increased number of iatrogenic colonic perforations. In order to minimize morbidity and mortality, prompt operative intervention is the best strategy in most patients. Non-operative management is warranted in carefully selected patients without peritoneal irritation.

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Authors+Show Affiliations

Farley DR
Division of Gastroenterologic and General Surgery, Mayo Clinic Rochester, Minnesota 55905, USA.
Bannon MP
No affiliation info available
Zietlow SP
No affiliation info available
Pemberton JH
No affiliation info available
Ilstrup DM
No affiliation info available
Larson DR
No affiliation info available

MeSH

AdultAgedAged, 80 and overAlgorithmsColectomyColonic DiseasesColonoscopyDiagnosis, DifferentialEmergenciesFemaleHumansIntestinal PerforationLaparotomyMaleMedical RecordsMiddle AgedPostoperative ComplicationsRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9276600

Citation

Farley, D R., et al. "Management of Colonoscopic Perforations." Mayo Clinic Proceedings, vol. 72, no. 8, 1997, pp. 729-33.
Farley DR, Bannon MP, Zietlow SP, et al. Management of colonoscopic perforations. Mayo Clin Proc. 1997;72(8):729-33.
Farley, D. R., Bannon, M. P., Zietlow, S. P., Pemberton, J. H., Ilstrup, D. M., & Larson, D. R. (1997). Management of colonoscopic perforations. Mayo Clinic Proceedings, 72(8), 729-33.
Farley DR, et al. Management of Colonoscopic Perforations. Mayo Clin Proc. 1997;72(8):729-33. PubMed PMID: 9276600.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of colonoscopic perforations. AU - Farley,D R, AU - Bannon,M P, AU - Zietlow,S P, AU - Pemberton,J H, AU - Ilstrup,D M, AU - Larson,D R, PY - 1997/8/1/pubmed PY - 1997/8/1/medline PY - 1997/8/1/entrez SP - 729 EP - 33 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 72 IS - 8 N2 - OBJECTIVE: To document our evolving surgical management of colonoscopic perforation and examine factors crucial to the improvement of patient care. DESIGN: We conducted a computer-based retrospective analysis of medical records (1980 through 1995). MATERIAL AND METHODS: Among 57,028 colonoscopic procedures performed, 43 patients (0.075%, or 1 perforation in 1,333 procedures) had a colonic perforation. Two additional patients were treated after colonoscopy performed elsewhere. The outcomes analyzed included surgical morbidity and mortality. RESULTS: Twenty-six women and 19 men who ranged in age from 28 to 85 years (median, 69) were treated for colonic perforation. More than 80% of perforations occurred during the latter half of the study period because of the increased volume of colonoscopic procedures (8 perforations among 12,581 examinations from 1980 through 1987 versus 35 perforations among 44,447 colonoscopies from 1988 through 1995). Emergency laparotomy was performed in 42 patients (93%). Perforations occurred throughout the colon: right side = 10; transverse = 9; and left side = 23. Three patients without evidence of peritoneal irritation fared well with nonoperative management. Most patients underwent primary repair or limited resection in conjunction with end-to-end anastomosis. In 14 patients (33%), an ostomy was created. One patient underwent laparotomy without further treatment. Intra-abdominal contamination ranged from none (31%) to local soiling (48%) to diffusely feculent (21%). Postoperative complications occurred in 12 patients and were associated with older age (P = 0.01), large perforations (P = 0.03), and prior hospitalization (P = 0.04). No postoperative deaths occurred. CONCLUSION: Despite a consistently low risk of colonic perforation, the increasing use of colonoscopy in our practice has resulted in an increased number of iatrogenic colonic perforations. In order to minimize morbidity and mortality, prompt operative intervention is the best strategy in most patients. Non-operative management is warranted in carefully selected patients without peritoneal irritation. SN - 0025-6196 UR - https://www.unboundmedicine.com/medline/citation/9276600/Management_of_colonoscopic_perforations_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)63592-1 DB - PRIME DP - Unbound Medicine ER -