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A Multicenter Review

Anthony Yuen Bun Teoh, MRCS (Edin); Chi Ming Poon, FRCS (Edin); Janet Fung Yee Lee, MD; Hing Tat Leong, FRCS (Edin); Simon Siu Man Ng, FRCS (Edin); Joseph Jao Yiu Sung, PhD, MD; James Yun Wong Lau, FRCS (Edin)

Arch Surg. 2009;144(1):9-13.

Objectives  To perform a retrospective review of all patients with colonoscopic perforations managed in hospitals within the Eastern New Territories region of Hong Kong and to determine the predictors of mortality and stoma formation in patients with colonoscopic perforations.

Design  Retrospective computer-based review.

Setting  Multicenter (1 university teaching hospital and 2 district hospitals).

Methods  We reviewed the outcomes of patients with colonoscopic perforations surgically managed between January 1, 1998, and December 31, 2005. Predictors of mortality and stoma formation were identified with multivariable analysis.

Main Outcome Measures  Mortality and stoma rates and their predictors.

Results  A total of 37 971 colonoscopies were performed during the study period, and 43 colonoscopic perforations were identified. The overall perforation rate was 0.113% and represented a decreasing trend. There was no significant difference in the perforation rate between gastroenterologists (0.148%) and surgeons (0.091%) (P = .15). Perforations that occurred during diagnostic colonoscopies were significantly larger than those that occurred during therapeutic colonoscopies (P = .04), and the patients presented earlier (P = .02). Surgical intervention was performed in 39 patients. The overall morbidity and mortality rate was 48.7% and 25.6%, respectively. The stoma rate was 38.5%. The predictors of stoma formation include moderate to severe peritoneal contamination and the presence of malignant colonic neoplasms (P = .01 and P = .008, respectively). The predictors of mortality include American Society of Anesthesiologists class 3 or higher and antiplatelet therapy (P = .009 and P = .001, respectively).

Conclusions  Colonoscopic perforations were in a decreasing trend. Patients with predictors of mortality should not be treated conservatively. Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low.

Author Affiliations: Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital (Drs Teoh, Lee, Ng, and Lau); Department of Surgery (Drs Teoh, Poon, and Leong) and Endoscopy Unit (Dr Leong), North District Hospital; Department of Surgery and Endoscopy Unit, Alice Ho Miu Ling Nethersole Hospital (Dr Leong); and Endoscopy Unit, Prince of Wales Hospital (Drs Sung and Lau), Hong Kong SAR, China.

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