Management of colonoscopic perforation: a systematic review and treatment algorithm
The aim of this review is to evaluate and summarize the current strategies used in the management of colonoscopic perforations as well as propose a modern treatment algorithm.
Articles published between January 2004 and January 2019 were screened. A total of 167 reports were identified in combined literature search, of which 61 articles were selected after exclusion of duplicate and unrelated articles. Only studies that reported on the management of endoscopic perforation in an adult population were retrieved for review. Case reports and case series of 8 patients or less were not considered. Ultimately, 19 articles were considered eligible for review.
A total of 744 cases of colonoscopic perforations were reported in 19 major articles. The cause of perforation was mentioned in 16 articles. Colonoscopic perforations were reported as a consequence of diagnostic colonoscopies in 222 cases and therapeutic colonoscopies in 248 cases. The site of perforation was mentioned in 486 cases. Sigmoid colon was the predominant site followed by the cecum. The management of colonoscopic perforations was reported in a total of 741 patients. Surgical intervention was employed in 75% of the patients, of these 15% were laparoscopic and 85% required laparotomy. The predominant surgical intervention was primary repair.
Management strategies of colon perforations depend upon the etiology, size, severity, location, available expertise, and general health status. Usually, peritonitis, sepsis, or hemodynamic compromise requires immediate surgical management. Endoscopic techniques are under continuous evolution. Newer developments have offered high success rate with least amount of post-procedure complications. However, there is a need for further studies to compare the newer endoscopic techniques in terms of success rate, cost, complications, and the affected part of colon.
KeywordsManagement Treatment Colonoscopy Colonoscopic perforation
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Khalid N. Alsowaina, Mooyad A. Ahmed, Nawar A. Alkhamesi, Ahmad I. Elnahas, Jeffrey D. Hawel, Nitin V. Khanna, and Christopher M. Schlachta have no conflicts of interest or financial ties to disclose.
- 28.Sileri P, Blanco GDV, Benavoli D, Gaspari AL (2009) Iatrogenic rectal perforation during operative colonoscopy: closure with endoluminal clips. J Soc Laparoendosc Surg 13(1):69Google Scholar
- 31.Ignjatović M, Jović J (2008) Tension pneumothorax, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopic polypectomy: a case report and review of the literature. Langenbeck’s Arch Surg 394(1):185–189Google Scholar
- 34.Hassan MA, Thomsen CØ, Vilmann P (2016) Endoscopic treatment of colorectal perforations—a systematic review. Danish Med J 63(4):A5220Google Scholar
- 38.De Angelis N, Di Saverio S, Chiara O, Sartelli M, Martínez-Pérez A, Patrizi F et al (2018) 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg 13:5Google Scholar
- 41.Martínez MG, Poblador AR, Raposo LG, Fernández AG, Núnez JC (2007) Perforation after colonoscopy-our 16-year experience. Rev Esp Enferm Dig 99(10):588Google Scholar
- 53.Miranda L, Settembre A, Piccolboni D, Capasso P, Corcione F (2011) Iatrogenic Colonic Perforation. Surg Laparosc, Endosc Percutaneous Tech 21(3):170–174Google Scholar
- 68.Von Renteln D, Schmidt A, Vassiliou M, Rudolph H-U, Gieselmann M, Caca K (2009) Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 41(06):481–486Google Scholar
- 69.Al Ghossaini N, Lucidarme D, Bulois P (2014) Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Digest Liver Dis 46(3):195–203Google Scholar