title: Management of latrogenic perforation after gastrointestinal endoscopy.
abstract: OBJECTIVE
  Gastrointestinal perforation during endoscopy is a rare but severe complication. Most instances occur during colonoscopy.
  
  
  METHODS
  We retrospectively evaluated the cases of 23 patients with iatrogenic perforation (13 women, 10 men; mean age = 71 years [range, 49-89]). We identified 6 esogastric perforations, 2 endoscopic retrograde cholangiopancreatography (ERCP)-related perforations, and 15 colonic perforations. Demographics, type and aim of endoscopy, mechanism of perforation, delay of treatment, operative procedure, postoperative hospital stay, and mortality rate were analyzed.
  
  
  RESULTS
  Three perforations occurred during diagnostic gastroscopy and 3 during therapeutic gastroscopy. ERCP-related perforations occurred during therapeutic procedures. Nine colonic perforations occurred during interventional colonoscopy. ERCP-related perforations always required laparotomy. For esogastric perforations, surgical treatment usually required laparotomy; only two patients (33%) could be managed by laparoscopy. In contrast, colon perforations could be managed by a laparoscopic approach (suturing and drainage or by laparoscopic resection) in 86.6% of cases. Overall mortality was 13% and occurred exclusively after esogastric perforation.
  
  
  CONCLUSIONS
  Most gastrointestinal perforations occurred during therapeutic colonoscopy; these perforations could be treated by laparoscopy in most cases. Esogastric perforations and perforations after ERCP are rare and must be treated on a case-by-case basis; in most cases, laparotomy is required.
authors: Department of Digestive, Thoracic and Laparoscopic surgery, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium. viviane.thill@chu-brugmann.be
authors: V
authors: V
authors: Thill
authors: Ch
authors: Ch
authors: Simoens
authors: P
authors: P
authors: Mendes da Costa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D003113:Colonoscopy / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors