title: Risk factors for colonic perforation after screening computed tomographic colonography: a multicentre analysis and review of the literature.
abstract: BACKGROUND
  Computed tomographic (CT) colonography (or 'virtual' colonoscopy) has become an increasingly popular tool for colorectal cancer screening. Colonic perforation, an uncommon complication, is a risk that has not been widely reported.
  
  
  METHODS
  A systematic review of the literature was undertaken to identify all reported risk factors for colonic perforation following CT colonography. In addition, a retrospective multicentre study was undertaken, evaluating all CT colonographies in 10 major metropolitan tertiary referral centres. All colonic perforations were assessed for risk factors.
  
  
  RESULTS
  A range of 'patient'-related and 'procedure'-related risk factors were identified in the literature. Among 3458 CT colonographies, there were two cases of colonic perforation contributing to an incidence of perforation of 0.06%. There was no statistical correlation between the incidence of perforation and institutional experience (P = 0.66). Risk factors common to both cases and the literature included age, recent colonoscopy and manual colonic insufflation. Diverticular disease and recent colonic biopsy were also notable factors.
  
  
  CONCLUSIONS
  There is a small but real risk of perforation following CT colonography. Patient selection and preventative procedural measures may reduce this risk. The importance of the consent process is emphasized.
authors.affiliation: Department of Surgery, Western Hospital, Gordon St, Footscray, Victoria, Australia.
authors.forename: Mohamed Anwar
authors.initials: MA
authors.lastname: Atalla
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Olga Dorota
authors.initials: OD
authors.lastname: Niewiadomski
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Croxford
authors.forename: Wa
authors.initials: W
authors.lastname: Cheung
authors.forename: Yik-Hong
authors.initials: YH
authors.lastname: Ho
mesh_terms: D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D006801:Humans; D012307:Risk Factors