Incidence and management of colonoscopic colon perforations: 10 years' experience.
OBJECTIVE
This paper aimed to review experience with diagnostic and therapeutic colonoscopies performed by a colorectal surgeon with special interest in colonoscopy over a 10-yr period and to assess incidence and management of colonic perforations.


METHODS
All colonoscopies performed between 1997 and 2007 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from computerized database. Medical records of patients with colonic perforation were reviewed.


RESULTS
7,804 colonoscopies were performed. Five colonoscopic perforations were identified (0.06%). Three occurred during diagnostic and two during therapeutic colonoscopy. All were suspected during or immediately after colonoscopy except for one therapeutic perforation diagnosed two days after the procedure. All perforations were surgically managed by the author. Surgery included conventional and laparoscopic repair, colectomy and proctocolectomy. There was need for stoma in one patient with pancolonic Crohn's disease with sigmoid colon stenosis. This patient underwent total proctocolectomy. There were no deaths.


CONCLUSIONS
The rate of perforation during colonoscopy is low and can be managed with no mortality. Early diagnosis and treatment are essential. Early operative intervention through primary repair represents is safe and effective. Managing colonic pathology demanding resection in the urgent setting may benefit selected patients with colonoscopy perforation.
Araujo
Sergio Eduardo Alonso
SE
Endoscopy Unit, Hospital Santa Helena, São Paulo, SP, Brazil. sergioed@terra.com.br
Seid
Victor Edmond
VE
Caravatto
Pedro Paulo de Paris
PP
Dumarco
Rodrigo
R
D000368:Aged; D003108:Colonic Diseases / Q000453:epidemiology* / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged