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Corey W. Iqbal, MD; Daniel C. Cullinane, MD; Henry J. Schiller, MD; Mark D. Sawyer, MD; Scott P. Zietlow, MD; David R. Farley, MD

Arch Surg. 2008;143(7):701-707.

Background  Increasing use of colonoscopy is making iatrogenic perforations more common. We herein present our experience with operative management of colonoscopic-related perforations.

Design  Retrospective review (1980-2006).

Setting  Tertiary referral center.

Patients  A total of 258 248 colonoscopies performed in patients, from which we identified 180 iatrogenic perforations (incidence, 0.07%). Of these, 165 perforations were managed operatively.

Results  Patients underwent primary repair (29%), resection with primary anastomosis (33%), or fecal diversion (38%). Patients presenting within 24 hours (78%) were more likely to have minimal peritoneal contamination (64 patients [50%] vs 6 [17%]; P = .01) and to undergo primary repair or resection with anastomosis (86 [67%] patients vs 13 [36%]; P < .01). Patients presenting after 24 hours (22%) were more likely to have feculent contamination (16 patients [44%] vs 4 [11%]; P = .02) and to receive an ostomy (23 patients [64%] vs 43 [33%]; P = .02). The sigmoid colon was the most frequent site of perforation, followed by the cecum (53% and 24%, respectively; P < .001); blunt or torque injury exceeded polypectomy and thermal injuries (55% vs 27% and 18%, respectively; P < .001). Patients with blunt injuries were more likely to receive a stoma than were those with polypectomy and thermal perforations (44 patients vs 9 and 9, respectively; P = .02), as were patients with feculent peritonitis compared with those with moderate and minimal soilage (28 patients [78%] vs 28 [42%] and 6 [10%] respectively; P = .002). Operative morbidity was 36%, with a mortality rate of 7%. Multivariate analysis indicated that blunt injuries, poor bowel preparation, corticosteroid use, and being younger than 67 years were risk factors for postoperative morbidity (P  .01); no factors correlated with death.

Conclusions  Colonoscopic perforation occurs in fewer than 1 in 1000 patients and is associated with significant morbidity and mortality. Prompt diagnosis and operative therapy are critical in most cases.

Author Affiliations: Divisions of Gastroenterologic and General Surgery (Drs Iqbal and Farley) and Trauma, Critical Care, and General Surgery (Drs Cullinane, Schiller, Sawyer, and Zietlow), Mayo Clinic College of Medicine, Rochester, Minnesota.

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