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Iatrogenic Colonic Perforations

Changing the Paradigm

Ulla-Rocha, Jose Luis MD, PhD*; Salgado, Angel MD; Sardina, Raquel MD; Souto, Raquel MD*; Sanchez-Santos, Raquel MD, PhD§; Turnes, Juan MD, PhD*

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: June 2019 - Volume 29 - Issue 3 - p 173–177
doi: 10.1097/SLE.0000000000000610
Original Articles
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Purpose: The purpose of our study was to investigate the clinical outcomes of colonoscopic perforations in patients.

Materials and Methods: We retrospectively studied patients with perforations secondary to diagnostic/therapeutic colonoscopy between 2009 and 2015 at the Pontevedra Hospital Complex. We analyzed age, closure method, length of hospitalization, and long-term progress.

Results: Of the 34 perforations detected, 67.6% occurred in patients aged below 75 years. Most perforations occurred in the descending colon (55%). Perforations occurred in 55.9% of outpatients and 45% of inpatients. Diagnostic and therapeutic colonoscopies caused perforations in 20.6% and 79.4% of patients, respectively. Conservative treatment alone was performed in 5.9%, complete or partial endoscopic closure in 14.7%, and surgery in 79.4% of patients. Patients treated only conservatively or with concomitant endoscopic closure showed no mortality. The mortality rate was 14.8% in those treated surgically, and 55% of these patients required a subsequent ostomy.

Conclusions: Conservative management with antibiotics and parenteral nutrition concomitant with complete/partial endoscopic closure effectively treats perforations, provided intraprocedural diagnosis is possible with immediate administration of antibiotics after the procedure. Nevertheless, studies with larger number of patients and statistical analysis are necessary in the near future.

*Digestive Diseases Unit

§Surgery Unit, Pontevedra Hospital Complex, Pontevedra

Southern Biomedical Foundation, Vigo

Department of Internal Medicine, Ferrol Hospital Complex, Ferrol, Spain

The authors declare no conflicts of interest.

Reprints: Jose Luis Ulla-Rocha, MD, PhD, Digestive Diseases Unit, Pontevedra Hospital Complex, C/Cruz Gallastegui 16 3-A Pontevedra, Pontevedra 36001, Spain (e-mail: joseluisulla@gmail.com).

Received December 22, 2017

Accepted October 28, 2018

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