Iatrogenic Perforations during Colonoscopy
H. Doran, I.T. Marin, M. Iaciu, T. PătraşcuOriginal article, no. 4, 2014
The incidence of iatrogenic colonic perforations in the medicalliterature ranges between 0.005% and 0.63% with the majorityof patients requiring laparotomy for repair. Colonoscopicperforation may occur due to several mechanisms: blunt traumato the colonic wall, barotrauma from air insufflation,unintentional endoscopic resection or excessive thermalinjury. Our clinical experience includes 1,953 colonoscopies,performed by three surgeons over the course of five years,between 2008 and 2012. During this period of time, fourcolonic perforations occurred, which corresponds to anincidence of 0.2%. None of these four colonoscopiesincluded therapeutic procedures. Two of the four lesions werediagnosed during the procedure, while the other two werediagnosed after 24 hours. All patients needed a laparotomy forrepair. Segmental colonic resections were performed in threecases, followed by a primary anastomosis (one case) or by aterminal colostomy (two cases). In the fourth patient, inwhom a generalized peritonitis had developed, the suture ofthe perforation protected by a lateral colostomy was thoughtto be a safer solution. Colostomies were removed six monthsafter the first operation. No major post-operative morbidity ormortality were recorded. Age over 75 years, female gender, lower BMI, associated comorbidities and diverticulitis wereidentified as possible risk factors associated with theseinjuries.
