This paper is only available as a PDF. To read, Please Download here.
Background
Because iatrogenic colonic perforation is uncommon, surgical management of this complication
has been based on the civilian trauma experience. In this study, we determine the
incidence, clinical presentation, and management of colonic perforations resulting
from colonoscopy or barium enema.
Patients and Methods
The medical records of all patients with colorectal perforations due to barium enema
or colonoscopy seen over a 5-year period were reviewed.
Results
Twenty-one patients, 12 males and 9 females aged 66 ± 16 years, undergoing evaluation
for polyps and bleeding (11), diverticulosis (4), diarrhea (2), or miscellaneous indications
(4) sustained colonic perforation from colonoscopy (18; 0.20%) or barium enema (3;
0.10%). Abdominal pain, 66% (13), and fever, 24% (5), were the most frequent symptoms
encountered and extraluminal air, 67% (14), the most common radiologic finding. The
site of perforation was the rectosigmoid in 62% (13) of patients.
Eighteen patients underwent surgery; 11 within 24 hours (group I) and 7 patients within
6.0 ± 4 days (group II). Fifty percent (9 of 18) had primary repair or resection with
anastomosis without mortality. Of the 6 patients initially treated nonoperatively,
3 subsequently underwent surgery. Both deaths, one in group I and one in group II,
occurred in patients who had colonic diversion for perforation following colonoscopy.
Conclusion
We conclude that in the absence of significant contamination either primary repair
or resection and anastomosis can be performed with acceptable morbidity for iatrogenic
perfortions of the colon.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management of barium enema-induced colorectal perforation.Am Surg. 1992; 58: 673-676
- Colon perforation during colonoscopy: surgical versus conservative management”.Br J Surg. 1991; 78: 542-544
- Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.Gut. 1983; 24: 376-383
- The management of perforating injuries of the colon and rectum in civilian practice.Surgery. 1951; 29: 305-320
- Colon perforations occurring during sigmoidoscopic examinations and barium enemas.Missouri Med. 1968; 65: 969-974
- Perforations from colonoscopy during diagnosis and therapy of polyps.Ann Chir Gynecol. 1986; 75: 142-150
- Iatrogenic perforation of the colon and rectum.Dis Colon Rect. 1982; 25: 305-308
- ‘Mini-perforation’ of the colon: not all postpolypectomy perforations require laparotomy.Dis Colon Rect. 1991; 34: 132-135
- Perforation of the colon above the peritoneal reflection during the barium-enema examination.Radiology. 1982; 144: 253-255
- Management of perforations due to colonoscopy.Dis Colon Rect. 1983; 6: 61-63
- Management of colonic perforation after colonoscopy: report of three cases.Dis Colon Rect. 1989; 32: 624-626
- Perforation of the large bowel during colonoscopy in Singapore.Am Surg. 1990; 56: 285-288
- Complications of gastrointestinal radiologic procedures: complications of routine fluoroscopic studies.Gostrointes Radiol. 1980; 5: 293-315
- Recognition and prevention of barium enema complications.Curr Probl Diagn Radiol. 1991; 20: 123-151
- Effect of fluid administration and operation on the mortality rate in barium peritonitis.Surgery. 1971; 70: 778-781
- Barium granuloma within the peritoneal cavity: ureteral obstruction 7 years after barium enema and colonic perforation.Ann Surg. 1966; 164: 162-166
- Air pressure induced colon injury during diagnostic colonoscopy.Gastroenterology. 1980; 78: 7-14
- Management of perforation of the colon at colonoscopy.Am J Gastroent. 1992; 87: 161-167
- Value of computed tomography in detecting occult gastrointestinal perforation.J Comput Assist Tomogr. 1983; 7: 825-827
- Management of perforations with polypoid lesions of the colon: current concepts and controversies.Am J Gostroent. 1979; 71: 315-324
Article info
Footnotes
**Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.
Identification
Copyright
© 1996 Excerpta Medica, Inc. All rights reserved. Published by Elsevier Inc.
