Abstract
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 perforations of the colon.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 454-458 |
| Number of pages | 5 |
| Journal | American Journal of Surgery |
| Volume | 172 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 1996 |
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ASJC Scopus subject areas
- Surgery
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Clinical presentation and management of iatrogenic colon perforations. / Gedebou, Tewodros M.; Wong, Randy A.; Adamas-Rappaport, William -; Jaffe, Philip; Kahsai, Daniel; Hunter, Glenn C.
In: American Journal of Surgery, Vol. 172, No. 5, 11.1996, p. 454-458.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinical presentation and management of iatrogenic colon perforations
AU - Gedebou, Tewodros M.
AU - Wong, Randy A.
AU - Adamas-Rappaport, William -
AU - Jaffe, Philip
AU - Kahsai, Daniel
AU - Hunter, Glenn C.
PY - 1996/11
Y1 - 1996/11
N2 - 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 perforations of the colon.
AB - 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 perforations of the colon.
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UR - http://www.scopus.com/inward/citedby.url?scp=0030298023&partnerID=8YFLogxK
U2 - 10.1016/S0002-9610(96)00236-X
DO - 10.1016/S0002-9610(96)00236-X
M3 - Article
C2 - 8942543
AN - SCOPUS:0030298023
VL - 172
SP - 454
EP - 458
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 5
ER -