Surgical Endoscopy

, Volume 33, Issue 12, pp 3889–3898 | Cite as

Management of colonoscopic perforation: a systematic review and treatment algorithm

  • Khalid N. AlsowainaEmail author
  • Mooyad A. Ahmed
  • Nawar A. Alkhamesi
  • Ahmad I. Elnahas
  • Jeffrey D. Hawel
  • Nitin V. Khanna
  • Christopher M. Schlachta
Review Article



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.


Management Treatment Colonoscopy Colonoscopic perforation 



No funding to be reported.

Compliance with ethical standards


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.


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Copyright information

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

Authors and Affiliations

  1. 1.Canadian Surgical Technologies & Advanced Robotics (CSTAR)LondonCanada
  2. 2.Department of SurgeryWestern UniversityLondonCanada
  3. 3.Department of MedicineWestern UniversityLondonCanada

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