Early Surgical Treatment of Colonoscopic Perforations

INTRODUCTION: Colonoscopy is widely used for diagnostic and therapeutic purposes in colon, rectum, and anal canal diseases. Although colonoscopic perforations are rare, they can lead to serious morbidity and mortality. The aim of this study was to examine the diagnosis, treatment, and follow-up results of the patients operated for colonoscopic perforation in the light of the literature.
METHODS: The results of the patients, who were operated in our clinic with the diagnosis of colonoscopic perforation between January 2015 and November 2019, were evaluated retrospectively. The patients’ demographic characteristics, colonoscopy findings, disease diagnoses, time of surgery, and surgery performed and follow-up results were analyzed.
RESULTS: A total of 7802 colonoscopy procedures were performed. Ten patients (0.12%) developed colonoscopic perforation. Of the patients, 6 (60%) were female and 4 (40%) were male. The mean age was 71.5 years. Perforation developed during the diagnostic procedure in 7 patients (70%) and during polypectomy in 3 patients (30%). Perforation localization was the sigmoid colon in seven patients, the rectosigmoid junction in two patients, and the right colon in one patient. All patients were operated within 6 h after the procedure. Six patients underwent primary repair, three patients underwent segmental colon resection + end-to-end anastomosis, and one patient underwent multiple surgeries. While two patients developed minor complications, one patient died on the 6th day after the procedure due to intra-abdominal sepsis.
DISCUSSION AND CONCLUSION: Although the incidence of colonoscopic perforation is low, it causes serious morbidity and mortality when it develops. Patients and their relatives should be informed in detail about possible complications before colonoscopy. Although there is no gold standard treatment, we believe that the diagnosis should be made as early as possible and appropriate treatment should be performed without delay.