Iatrogenic colonic perforation by colonoscopy: a fatal complication for patients with a high anesthetic risk.
OBJECTIVE
Colonoscopy is currently a standard and widespread technique used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is an unfortunate complication that can induce significant morbidity and even death. Here, we reviewed the clinical results of iatrogenic colonoscopic perforation in our hospital.


METHODS
This was a retrospective review of 35,186 colonoscopies performed in the Tri-Service General Hospital, Taipei, Taiwan from January 1998 to December 2007. Patient demographic data, indications, comorbidities, operative history, perforation site, time of diagnosis, management, complications, hospital stay, and outcomes were recorded.


RESULTS
In this 10-year period, 23 cases of iatrogenic colonic perforation were recorded (0.065%) affecting 11 men and 12 women. The mean age was 71.2 years. There were 13 patients in American Society of Anesthesiology (ASA) classifications 1 or 2 (low anesthetic risk, group A), and ten patients in ASA classes 3 or 4 (high anesthetic risk, group B). The mean hospital stay was 12 days in group A versus 23.5 days in group B (P = 0.002). Moreover, four patients in group B died (17%; P = 0.024).


CONCLUSIONS
Colonoscopy-related perforation can progress to peritonitis and sepsis, resulting in serious morbidity or death. High-anesthetic risk patients with colonic perforation have a longer hospital stay and a poor prognosis. Hence, patients need to be informed of the complications of colonoscopy, and clinicians must be cautioned about the potential problems for patients with a high-anesthetic risk when performing the procedure.
Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Nei-Hu District 114, Taipei, Taiwan, Republic of China.
Chen-Ming
CM
Mai
Chia-Cheng
CC
Wen
Shu-Hui
SH
Wen
Kuo-Feng
KF
Hsu
Chang-Chieh
CC
Wu
Shu-Wen
SW
Jao
Cheng-Wen
CW
Hsiao
D000368:Aged; D000777:Anesthetics / Q000009:adverse effects; D003113:Colonoscopy / Q000009:adverse effects* / Q000401:mortality; D000075202:Contraindications; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007258:Informed Consent; D007416:Intestinal Perforation / Q000150:complications / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate
D000777:Anesthetics