Outcome of surgery for colonoscopic perforation


Dr A. F. Engel, Department of Surgery; Zaans Medical Centre, Koningin Julianaplein 58, PO Box 210, 1500 EE, Zaandam, The Netherlands.
E-mail: Engel.A@zaansmc.nl


Aim  The aetiology of colonoscopic perforation and factors related to poor outcome of surgical treatment were studied.

Method  A single-centre review was conducted of all patients who underwent surgical treatment of a colonoscopic perforation, identified from a prospective registry of 21 981 consecutive colonoscopies carried out between 1993 and 2009.

Results  There were 29 (eight women) patients of mean age 73 years including 10 who had a nonelective colonoscopy. The perforation was not immediately recognized in 12 patients and in the remaining 17, seven were initially managed conservatively. The causes of perforation were barotrauma (11), mechanical force (14) and polypectomy-related (3). Barotrauma was more frequent in emergency colonoscopy and mechanical force in elective colonoscopy. The outcome of surgery was as follows: mortality 10%, complications 34.5%, reoperation 14%, secondary surgery 23% and permanent colostomy 3%. The only factor related to in-hospital mortality was an increased American Society of Anesthesiologists (ASA) score.

Conclusion  Colonoscopic perforation requiring surgery is a catastrophic event with high mortality, morbidity and reoperation rates.