Skip to main content
SpringerLink
Log in

Management of Colonoscopy Complications

  • Chapter
  • First Online:
Emergency Surgical Management of Colorectal Cancer

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

  • 764 Accesses

Abstract

Complications after colonoscopy range from asymptomatic and self-limiting to serious life-threatening conditions. The most worrying complication is iatrogenic colonic perforation (ICP) due to barotrauma and mechanical trauma when the endoscope is pushed forward or to thermal/electrical injury of the colonic wall, with onset of symptoms after 24–72 h. CT scan is effective to detect even small amounts of fluid or air in the peritoneal or retroperitoneal space. Nonoperative management is appropriate for small sealed-off perforations, and endoscopic repair is possible intra-procedurally with small, large clips or sutures. Emergency surgery is indicated in signs of diffuse peritonitis, systemic inflammation, or sepsis. Laparoscopy is the first-line approach, and simple suture, wedge resection, segmental resection with anastomosis or stoma, and exteriorization of the perforation may be all performed laparoscopically. In unstable patients, open surgery is preferred. Bleeding is a complication after operative colonoscopies, which occurs with higher risk in resection of polyps larger than 2 cm or multiple, polyps in the right colon, and sessile polyps with villous histotype, anticoagulant or dual antiplatelet therapy. Treatment of bleeding is primarily endoscopic and rarely endovascular or surgical. Less frequent complications are cardiopulmonary events principally due to sedation and hernia strangulation due to increased abdominal pressure, splenic injury, and gas explosion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal cancer: a targeted updated systematic review for the US preventive services task force. Ann Intern Med. 2008;149:638–58.

    Article  Google Scholar 

  2. Rabeneck L, Paszt LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenerology. 2008;135:1899–906.

    Article  Google Scholar 

  3. https://www.cochrane.org/CD008506/COLOCA_the-use-of-nitrous-oxide-gas-during-colonoscopy-procedures.

  4. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–54.

    Article  Google Scholar 

  5. Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013;19:463–81.

    Article  CAS  Google Scholar 

  6. Manta R, Tremolaterra F, Arezzo A, Verra M, et al. Complications during colonoscopy: prevention, diagnosis and management. Tech Coloproctol. 2015;19:505–13.

    Article  CAS  Google Scholar 

  7. Samalavicius NE, Kazanavicius D, Lunevicius TP, et al. Incidence, risk, management and outcomes of iatrogenic full-thickness large bowel injury associated with 56882 colonoscopies in 14 Lithuanian hospitals. Surg Endosc. 2013;27:1628–163.

    Article  Google Scholar 

  8. Martinez MTG, Poblador AR, Raposo LG, Fernandez AMG, Nunez JRC. Perforation after colonoscopy: our 16 year experience. Rev Esp Enferm Dig. 2007;99:588–92.

    Google Scholar 

  9. Luning TH, Keemer-Gels ME, Barendregt WB, Tan ACITL, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc. 2007;21:994–7.

    Article  CAS  Google Scholar 

  10. Lohsiriwat V. Colonoscopy perforation: incidence, risk factors, management and outcome. World J Gatroenterol. 2010;16:425–30.

    Article  Google Scholar 

  11. Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: lesson from a 10-year study. Am J Gastroenterol. 2000;95:3418–22.

    Article  CAS  Google Scholar 

  12. Heldwein W, Dollhopf M, Rosch T, et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy. 2005;37:1116–22.

    Article  CAS  Google Scholar 

  13. Wang J, Zhang XH, Ge J, Yang CM, Liu JY, Zhao SL. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol. 2014;20:8282–7.

    Article  Google Scholar 

  14. Van Halsema EE, Van Hooft JE, Small AJ, et al. Perforations in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79:970–82.

    Article  Google Scholar 

  15. Ragg J, Garimella V, Cast J, Hunter IA, Hartley JE. Balloon dilatation of benign rectal anastomotic strictures: a review. Dig Surg. 2012;29:287–91.

    Article  CAS  Google Scholar 

  16. Iqbal CW, Culliname DC, Schuller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg. 2008;14:6722–5.

    Google Scholar 

  17. Kim DH, Pickhard PJ, Taylor AJ, Menias CO. Imaging evaluation of complications at optical colonoscopy. Curr Probl Diagn Radiol. 2008;4:165–77.

    Article  Google Scholar 

  18. Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Scalea TM. Triple contrast helical T in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laparotomy. Am J Roentgenol. 2001;177:1247–56.

    Article  CAS  Google Scholar 

  19. De Angelis N, Di Saverio S, Chiara O, Sartelli M, Martinez-Perez A, Patrizi F, et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2018;13:5–25.

    Article  Google Scholar 

  20. Committee ASoP, Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74:745–52.

    Article  Google Scholar 

  21. Byeon JS. Colonic perforation: can we manage it endoscopically? Clin Endosc. 2013;46:495–9.

    Article  Google Scholar 

  22. Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC system in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc. 2013;27:2258–74.

    Article  Google Scholar 

  23. Stavropoulos SN, Modayil R, Friedel D. Current applications of endoscopic suturing. World J Gastrointest Endosc. 2015;7:777–89.

    Article  Google Scholar 

  24. Cho SB, Lee WS, Joo YE, Kim HR, Park CH, Kim HS, Choi SK, Rew JS. Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc. 2012;6:473–9.

    Article  Google Scholar 

  25. Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwt D, Kachinthorn U. What are the risk factors of colonoscopic perforations? BMC Gastroenterol. 2009;9:71–8.

    Article  Google Scholar 

  26. Shin DK, Shin SY, Park CY, Jin SM, Cho YH, Kim WH, et al. Optimal methods for the management of iatrogenic colonoscopic perforation. Clin Endosc. 2016;49:282–8.

    Article  Google Scholar 

  27. Di Saverio S, Patrizi F, Bassi M, Birindelli A, Nigro F, Cennamo V. Minimally invasive laparoscopic management of colonoscopic perforation avoiding laparotomy and colostomy: when and how to perform primary repair - a video vignette. Colorectal Dis. 2016;18:817–8.

    Article  Google Scholar 

  28. Agresta F, Michelet I, Mainente P, Bedin N. Laparoscopic management of colonoscopic perforations. Surg Endosc. 2000;14:592–3.

    Article  CAS  Google Scholar 

  29. Coimbra C, Bouffluoux L, Kohnen L, Deroover A, Dresse D, Denoel A, Honore P, Detry O. Laparoscopic repair of colonoscopic perforation: a new standard? World J Surg. 2010;34:1949–53.

    Article  Google Scholar 

  30. De’Angelis N, Di Saverio S, Chiara O, et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2018;13:5.

    Article  Google Scholar 

  31. Chiara O, Cimbanassi S, Biffl W, Leppaniemi A, Henry S, Scalea T, et al. International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg. 2016;80:173–83.

    Article  Google Scholar 

  32. Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatients colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849–57.

    Article  Google Scholar 

  33. Parra-Blanco A, Kaminaga N, Kojima T, Endo Y, Tajiri A, Fujita R. Colonoscopic polypectomy with cutting current: is it safe? Gastrointest Endosc. 2000;51:676–81.

    Article  CAS  Google Scholar 

  34. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective multicenter study of 1111 colorectal submucosal dissections. Gastrointest Endosc. 2010;72:1217–25.

    Article  Google Scholar 

  35. Parikh ND, Zanocco K, Keswani RN, Gawron AJ. A cost efficacy decision analysis of prophylactic clip placement after endoscopic removal of large polyps. Clin Gastroenterol Hepatol. 2013;11:1319–24.

    Article  Google Scholar 

  36. Luigiano C, Ferrara F, Ghersi S, et al. Endoclip assisted resection of large peduncolated colorectal polyps: technical aspects and outcome. Dig Dis Sci. 2010;55:1726–31.

    Article  Google Scholar 

  37. Jacques J, Legros R, Chaussade S, Sautereau D. Endoscopic hemostasis: an overview of procedures and clinical scenarios. Dig Liver Dis. 2014;46:766–76.

    Article  Google Scholar 

  38. Manta R, Galloro G, Mangiavillano B, et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc. 2013;27:3162–4.

    Article  Google Scholar 

  39. Soh B, Chan S. The use of superselective mesenteric embolization as a first line management of acute lower gastrointestinal bleeding. Ann Med Surg. 2017;17:27–32.

    Article  Google Scholar 

  40. Rao KV, Beri GD, Sterling MJ, Salen G. Splenic injury as a complication of colonoscopy: a case series. Am J Gastroenterol. 2009;104:1604–5.

    Article  Google Scholar 

  41. Chae HS, Kim SS, Han SW, et al. Herniation of the large bowel through a post-traumatic diaphragmatic defect during colonoscopy: report of a case. Dis Colon Rectum. 2002;45:1261–2.

    Article  Google Scholar 

  42. Ladas SD, Karamanolis G, Ben-Soussan E. Colonic gas explosion during therapeutic colonoscopy with electrocautery. World J Gastroenterol. 2007;13:5295–8.

    Article  Google Scholar 

  43. Riss S, Akan B, Mikola B, et al. CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial. Wien Klin Wochenschr. 2009;121:464–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgery, University of Milano, Milano, Italy

    Osvaldo Chiara

  2. General Surgery and Trauma Team Division, ASST Niguarda Hospital Milano, Milano, Italy

    Osvaldo Chiara & Stefania Cimbanassi

  3. Department of Surgery, University of Bologna, Bologna, Italy

    Arianna Birindelli

Authors
  1. Osvaldo Chiara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefania Cimbanassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arianna Birindelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osvaldo Chiara .

Editor information

Editors and Affiliations

  1. Department of General Surgery Unit of Digestive, Minimally Invasive and Robotic Surgery, Henri Mondor Hospital, Créteil, France

    Nicola de'Angelis

  2. Cambridge Colorectal Unit, Cambridge Biomedical Campus, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    Salomone Di Saverio

  3. Department of General Surgery Unit of Digestive, Minimally Invasive and Robotic Surgery, Henri Mondor Hospital, Créteil, France

    Francesco Brunetti

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chiara, O., Cimbanassi, S., Birindelli, A. (2019). Management of Colonoscopy Complications. In: de'Angelis, N., Di Saverio, S., Brunetti, F. (eds) Emergency Surgical Management of Colorectal Cancer. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-06225-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-06225-5_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-06224-8

  • Online ISBN: 978-3-030-06225-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation