[Injuries by colonoscopy and sigmoidoscopy requiring laparotomy. Claims to the Patient Insurance Corporation].
BACKGROUND
Endoscopic colonic injury occurs in < 1% and may require surgical intervention. Mortality in Scandinavian studies is 0-0.06% after colonoscopy.


METHODS
All claims to the Danish Patient Insurance Corporation from 1995-2005 were analysed. Indication, procedure, injury and course were registered.


RESULTS
111 had injury by colonoscopy and 11 by sigmoidoscopy in 46 departments. 80% were ASA I-II. Indications were symptoms (63%), postoperative follow-up (7%), polyp (27%) or colitis surveillance (3%). 63% had polypectomy. Three had splenic injury and underwent splenectomy. The commonest site of perforation was the sigmoid (61%). The injury was diagnosed immediately in 28%, and after 24 hours (range 8-240) in the remainder. Treatment of perforations included suture with ileostomy (9%) or without ileostomy (29%), resection and anastomosis with enterostomy (12%) or without enterostomy (46%). Five had intraoperative splenic injury. 31% had complications, 15% required reoperation. One suffered a stroke, and one died after 17 days. Hospital stay was 29 days median (3-203). 42% required intensive care for 7 days (1-56). Complications were significantly less frequent in those diagnosed immediately. 37% of those with stoma declined restoration of continuity. During restoration 3/47 had splenic injury. Postoperatively one had anastomotic leak, one had wound dehiscence, and two died.


CONCLUSIONS
Endoscopic colonic injury requiring laparotomy is serious and associated with a high rate of complications. Swift recognition and treatment may reduce the complication rate. Both primary and secondary surgical procedures should be handled by specialists.
Adamsen
Sven
S
Patientforsikringen, København. sven.adamsen@heh.regionh.dk
Mosbach
Karin K T
KK
Milliam
Palle B
PB
Hansen
Ole Hart
OH
D000368:Aged; D003106:Colon / Q000293:injuries*; D012809:Colon, Sigmoid / Q000293:injuries; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012812:Sigmoidoscopy / Q000009:adverse effects*; D013154:Spleen / Q000293:injuries