Incidence of clinically significant perforation at low dose non-contrast CT and its value prior to same day CT colonography following incomplete colonoscopy

  • Aileen O’SheaEmail author
  • Timothy Murray
  • Martina M. Morrin
  • Michael J. Lee
  • Eavan Thornton



Routine low dose non-contrast CT of the abdomen and pelvis has been suggested prior to same day completion CT colonography (CTC) to assess for occult perforation at preceding incomplete colonoscopy, before further gaseous insufflation at CTC. The aim of our study is to examine the incidence of clinically significant perforation at low dose CT. We also examine the benefits of low dose pre-scan in assessing adequacy of bowel preparation and identifying any other relevant contraindications to CT colonography.

Materials and methods

We conducted a retrospective review of all low dose non-contrast CTs performed following failed colonoscopies over a 4-year period (n = 392). We also assessed the adequacy of bowel preparation on a scale of 1–5, in order of increasingly adequate preparation. Incidentally noted bowel pathology and contraindications to CT colonography were also recorded.


No perforation was identified either prospectively or in the course of our retrospective review. However, 15 patients (3.8%) were found to have potential contraindications to CT colonography, including: acute diverticulitis, acute colitis, and poor bowel preparation. Overall, the bowel preparation was felt to be adequate (≥ 3) in 86% percent of patients. Two patients (0.5%) identified prospectively had their CT colonography postponed due to poor bowel preparation.


CT colonography Optical colonoscopy Colorectal cancer Same day CT colonography 



  1. 1.
    Spada C, Stoker J, Alarcon O, Barbaro F, Bellini D, Bretthauer M, et al. Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Endoscopy [Internet]. 2014 Sep 30 [cited 2018 Apr 28];46(10):897–915. Available from:
  2. 2.
    Franco DL, Leighton JA, Gurudu SR. Approach to Incomplete Colonoscopy: New Techniques and Technologies. Gastroenterol Hepatol (N Y) [Internet]. Millenium Medical Publishing; 2017 Aug [cited 2018 Apr 18];13(8):476–83. Available from:
  3. 3.
    Villa NA, Pannala R, Pasha SF, Leighton JA. Alternatives to Incomplete Colonoscopy. Curr Gastroenterol Rep [Internet]. 2015 Nov 16 [cited 2018 Jul 19];17(11):43. Available from:
  4. 4.
    Ridolfi TJ, Valente MA, Church JM. Achieving a Complete Colonic Evaluation in Patients With Incomplete Colonoscopy Is Worth the Effort. Dis Colon Rectum [Internet]. 2014 Mar [cited 2018 Jul 19];57(3):383–7. Available from:
  5. 5.
    Koido S, Ohkusa T, Nakae K, Yokoyama T, Shibuya T, Sakamoto N, et al. Factors associated with incomplete colonoscopy at a Japanese academic hospital. World J Gastroenterol [Internet]. 2014 Jun 14 [cited 2018 Jul 19];20(22):6961. Available from: CrossRefGoogle Scholar
  6. 6.
    Reumkens A, Rondagh EJA, Bakker CM, Winkens B, Masclee AAM, Sanduleanu S. Post-Colonoscopy Complications: A Systematic Review, Time Trends and Meta-Analysis of Population-Based Studies. Am J Gastroenterol [Internet]. Nature Publishing Group; 2016 Aug 14 [cited 2018 Aug 26];111(8):1092–101. Available from:
  7. 7.
    Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc [Internet]. 2009 Mar [cited 2018 Aug 26];69(3):654–64. Available from:
  8. 8.
    Gatto NM, Frucht H, Sundararajan V, Jacobson JS, Grann VR, Neugut AI. Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst [Internet]. 2003 Feb 5 [cited 2018 Aug 26];95(3):230–6. Available from: CrossRefGoogle Scholar
  9. 9.
    Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol [Internet]. Baishideng Publishing Group Inc; 2010 Jan 28 [cited 2018 Jun 4];16(4):425–30. Available from:
  10. 10.
    Panteris V, Haringsma J, Kuipers E. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy [Internet]. 2009 Oct 28 [cited 2018 Aug 26];41(11):941–51. Available from: CrossRefGoogle Scholar
  11. 11.
    Hough DM, Kuntz MA, Fidler JL, Johnson CD, Petersen BT, Kofler JM, et al. Detection of Occult Colonic Perforation Before CT Colonography After Incomplete Colonoscopy: Perforation Rate and Use of a Low-Dose Diagnostic Scan Before CO 2 Insufflation. Am J Roentgenol [Internet]. American Roentgen Ray Society; 2008 Oct 23 [cited 2018 Jun 4];191(4):1077–81. Available from:
  12. 12.
    Lara LF, Avalos D, Huynh H, Jimenez-Cantisano B, Padron M, Pimentel R, et al. The safety of same-day CT colonography following incomplete colonoscopy with polypectomy. United Eur Gastroenterol J [Internet]. SAGE Publications; 2015 Aug [cited 2018 Apr 3];3(4):358–63. Available from:

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Aileen O’Shea
    • 1
    Email author
  • Timothy Murray
    • 2
  • Martina M. Morrin
    • 3
  • Michael J. Lee
    • 3
  • Eavan Thornton
    • 4
  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Vancouver General HospitalVancouverCanada
  3. 3.Beaumont HospitalDublin 9Ireland
  4. 4.Bon Secours HospitalDublin 9Ireland

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