title: Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand.
abstract: OBJECTIVE
  To determine the incidence of colonoscopic perforation (CP), and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand.
  
  
  METHODS
  All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients' characteristics, endoscopic information, intra-operative findings, management and outcomes were analyzed.
  
  
  RESULTS
  A total of 17357 endoscopic procedures of the colon (13699 colonoscopies and 3658 flexible sigmoidoscopies) were performed in Siriraj hospital over a 9-year period. Fifteen patients (0.09%) had CP: 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon (80%), followed by the transverse colon (13%). Perforations were caused by direct trauma from either the shaft or the tip of the endoscope (n = 12, 80%) and endoscopic polypectomy (n = 3, 20%). All patients with CP underwent surgical management: primary repair (27%) and bowel resection (73%). The mortality rate was 13% and postoperative complication rate was 53%.
  
  
  CONCLUSIONS
  CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.
authors.affiliation: Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Prannok Road, Bangkok 10700, Thailand. bolloon@hotmail.com
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Sasithorn
authors.initials: S
authors.lastname: Sujarittanakarn
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.forename: Narong
authors.initials: N
authors.lastname: Lertakyamanee
authors.forename: Darin
authors.initials: D
authors.lastname: Lohsiriwat
authors.forename: Udom
authors.initials: U
authors.lastname: Kachinthorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000293:injuries*; D003113:Colonoscopy / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000009:adverse effects; D013785:Thailand / Q000453:epidemiology