Abstract:

OBJECTIVE: Colonoscopy is a widespread method used for both diagnostic and therapeutic purposes. It may have severe morbidity and mortality. In this study, patients managed for iatrogenic colonic perforations after colonoscopy were evaluated in terms of diagnosis, treatment and outcome. METHODS: Between January 1998 and March 2008 patients who were underwent surgery due to iatrogenic perforations after colonoscopy in our endoscopy unit were retrospectively evaluated. Demographic data, indications, endoscopic findings, treatments and follow-up results of patients were retrieved from files. RESULTS: Eight patients had iatrogenic colonic perforation. The distrubition of gender was equal.The mean age of patients were 61 years (43-87 years). Perforation occurred during colonoscopy in 7 patients and sigmoidoscopy in 1 patient. The number of perforation occurred during either diagnostic or therapeutic endoscopy was same. All perforations were in left colon (6 in sigmoid, 1 in rectosigmoid, 1 in descending colon). The mean time between the endoscopic evaluation and the operation was 18 hours (2-48 hours). While 4 patients were operated in the first 12 hours following endoscopic examination, 4 were operated after 12 hours. Colostomy was performed in five patients and primary repair was selected for 3 patients. Two patients had minor complication and 3 patients had died. CONCLUSION: Although the iatrogenic perforation rates are low, they cause serious morbidity and mortality. Patients and their relatives should be informed about the potential risks of the procedure. Suspicion of perforation during colonoscopy mandates close follow-up of patients in the surgical unit. Prompt recognition and early intervention are necessary for a successful outcome and minimization of the extent of surgical procedure. Perforations occurred after interventional procedures are recognized later. Hovewer, the diagnosis is not always straigthforward and still there is no consensus on any single treatment modality.

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