Colonoscopic Perforation; A 10-year Experience in Single General Hospital

Ji Eun Oh; Sang Goon Shim

doi:10.4166/kjg.2009.54.6.371

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Oh and Shim: Colonoscopic Perforation; A 10-year Experience in Single General Hospital

Original Article

Korean J Gastroenterol 2009;54(6):371-376.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.54.6.371

Colonoscopic Perforation; A 10-year Experience in Single General Hospital

Ji Eun Oh, M.D., Sang Goon Shim, M.D.

Department of Gastroenterology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Sang Goon Shim, M.D. Department of Internal Medicine, Masan Samsung Hospital, 50, Hapseong-dong, Masan 630-723, Korea Tel: +82-55-290-6013, Fax: +82-55-290-6654 E-mail: jeoh78@yahoo.co.kr

Received 13 August 2009 Accepted 17 September 2009

Abstract

Background/Aims

Colonoscopy is the principal method for diagnosis, treatment, and follow up of colorectal disease. The study aimed to assess the incidence, clinical features, and management of colonoscopic perforations at a local general hospital.

Methods

A retrospective review of patient record was performed for all patients with iatrogenic colonic perforation after sigmoidoscopy and colonoscopy between 1997 and 2007.

Results

In the 10-year period, 16,388 colonoscopic and sigmoidscopic procedure were performed. All 10 cases of procedure related colonic perforation were developed. Perforation occurred in 9 cases during therapeutic procedure; 5 cases due to polypectomy and 4 cases due to endoscopic submucosal dissection. Perforation occurred in one case during diagnostic procedure.

Conclusions

Therapeutic procedure is a clear risk factor of colonic perforation. When colonic perforation occurs, we should be able to make early diagnosis. Early diagnosis can lead to a good treatment and can produce good prognosis with short hospital days.

Keywords: Colonoscopy, Colon perforation, Operative surgical procedure, Clipping

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Fig. 1.

Plain film of the chest X-ray (A) and simple abdomen (B). After colon perforation, free air under the both diaphragm were noted.

Figs. 2.

Colonoscopic findings. (A) A small perforation was noted after polypectomy in the rectosigmoid junction. (B) The perforated opening was enclosed by endoclipping with 3 clips.

Table 1.

Type of Colonoscopic Procedures and Perforation Rate

	Type	Number of cases	Perforation incidence (%)
Total number	CFS＋SFS	16,388 (10,214＋6,174)	10 (0.06)
Diagnostic	CFS＋SFS	14,850 (8,824＋6,026)	1 (0.007)
Therapeutic	CFS＋SFS	1,538 (1,390＋148)	9 (0.59)
	Polypectomy	1,482	5 (0.34)
	ESD	10	4 (40)
	Bleeding	46	0 (0)

CFS, colonofiberscopy; SFS, sigmoiscopy; ESD, endoscopic submucosal dissection.

Table 2.

Colonoscopic Perforation Treatment

	Number of cases
Conservative treatment	Clipping	3
	Polypectomy	2
	ESD	1
Surgical treatment	Simple closure	4
	Segmentectomy with	1
	anastomosis
	Colostomy with anastomosis	1
	secondary
	Ileostomy	1

ESD, endoscopic submucosal dissection.

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