Iatrogenic Colonic Perforations: Changing the Paradigm

• Published in: Surgical laparoscopy, endoscopy & percutaneous techniques Vol. 29; no. 3; pp. 173 - 177
• Main Authors: Ulla-Rocha, Jose Luis, Salgado, Angel, Sardina, Raquel, Souto, Raquel, Sanchez-Santos, Raquel, Turnes, Juan
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-06-2019
• Subjects: Adult; Aged; Colon - surgery; Colonic Diseases - etiology; Colonic Diseases - therapy; Colonoscopy; Conservative Treatment - methods; Fasting - physiology; Female; Humans; Iatrogenic Disease; Intestinal Perforation - etiology; Intestinal Perforation - therapy; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Wound Closure Techniques; Young Adult
• ISSN: 1530-4515; 1534-4908
• DOI: 10.1097/SLE.0000000000000610

PURPOSE:The purpose of our study was to investigate the clinical outcomes of colonoscopic perforations in patients.
MATERIALS AND METHODS:We retrospectively studied patients with perforations secondary to diagnostic/therapeutic colonoscopy between 2009 and 2015 at the Pontevedra Hospital Complex. We analyzed age, closure method, length of hospitalization, and long-term progress.
RESULTS:Of the 34 perforations detected, 67.6% occurred in patients aged below 75 years. Most perforations occurred in the descending colon (55%). Perforations occurred in 55.9% of outpatients and 45% of inpatients. Diagnostic and therapeutic colonoscopies caused perforations in 20.6% and 79.4% of patients, respectively. Conservative treatment alone was performed in 5.9%, complete or partial endoscopic closure in 14.7%, and surgery in 79.4% of patients. Patients treated only conservatively or with concomitant endoscopic closure showed no mortality. The mortality rate was 14.8% in those treated surgically, and 55% of these patients required a subsequent ostomy.
CONCLUSIONS:Conservative management with antibiotics and parenteral nutrition concomitant with complete/partial endoscopic closure effectively treats perforations, provided intraprocedural diagnosis is possible with immediate administration of antibiotics after the procedure. Nevertheless, studies with larger number of patients and statistical analysis are necessary in the near future.