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Colonoscopic Perforations: A Retrospective Review
Corey W. Iqbal, Mayo Clinic, Rochester, MN; Yun Shin Chun, Memorial Sloan Kettering, New York, NY; David Farley, Mayo Clinic, Rochester, MN

Background/Objective:
Colonic perforation is no longer a rare complication of colonoscopy. Our previous report identified forty-five such iatrogenic injuries from 1980-1994 (x=3,082 colonoscopies/yr). This current follow-up of the ensuing seven years examines changing trends of endoscopic usage in addition to management and prognosis of patients suffering colonoscopic perforations.

Design:
Retrospective analysis of 78,702 colonoscopies (1994-2000, x=11,243 colonoscopies/yr) allowed assessment of medical records in all patients treated at our institution for colonic perforation.

Results:
Sixty-six patients from our institution (perforation rate=0.084%) and six patients from outside institutions were treated for colonic perforation following colonoscopy (41 women, 31 men; ages=30-92, median=73). Sixty-two patients underwent laparotomy, while ten were managed non-operatively. All ten patients managed non-operatively were void of peritoneal irritation by physical exam; eight patients did well (median hospital stay=5.5 days, range=0-12), but one death (family declined operative intervention) and one pelvic abscess requiring percutaneous drainage were noted. Peritoneal irritation by physical exam was evident in fifty-seven of sixty-two patients undergoing laparotomy. Perforations occurred throughout the colon: right=22 (31%); transverse=5 (7%); left=44 (61%); and unknown=1 (1%). Thirty-eight patients (61%) underwent primary repair or resection with anastomosis. Fecal diversion was used in all patients with extensive peritoneal contamination (n=12) and twelve out of thirty patients with moderate contamination (40%). Peri-operative morbidity (39%) and mortality (8%) were significant. Factors predicting a poor outcome included delayed daignosis, extensive peritoneal contamination, and patients using anticoagulants (p<0.05).

Conclusions:
Compared to our prior study, the present review highlights a higher prevalence of injury based on more frequent usage of colonoscopy. Perforation rates remain around 0.1%. Expedient surgical intervention facilitates patient recovery.


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