Endoscopic perforations of colon and rectum

Abstract

Although fiberoptic examination of the colon is nowdays considered to be safe procedure, endoscopic perforation remains rare, but serious and potentially life threatening complication. General incidence od diagnostic and interventional perforations of colon ranges, according to the literature between 0.1- 0.9%, or for diagnostic procedure about 0.17%, and for interventional 0.41%, with general mortality rate of 0,006%. In spite of the general trend for diminishing this occdurence, it is necessary to compare various experiences in order to achieve an algorrhithm of early diagnostic and the way of the surgical management of this particular kind of perforation. The aim of this work is to present the experience in 1995-2004 period, upon 7 (0,12%) cases of surgically treated perforations of colon after 5,680 performed diagnostic colonoscopies. In all 7 cases the reason for perforation was not basically pathologiocal process. 4 cases of perforations were recognized immediately, and they were managed by direct suture of the perforation. In 3 cases diagnosis was late from 1 to 3 days, and two-step operative procedure was performed in septic condition. Subjective and clinical signs of perforations were not always uniform, but in all 7 cases there were clear X-ray signs of free intraabdominal air. Surgical treatment was successful, and without deaths. In the algorrhithm of surgical diagnostic and procedure, the same principles and criteria used for civilian injuries of colon are to be used.