Treatment and outcomes of iatrogenic colon perforations at a community teaching hospital

Abstract

Despite the growing expertise in colonoscopy, it remains subject to complications. The previously published rate of colonoscopic perforation is 0.82 per 1000 examinations. The objective of this study was to describe the experience and management of colonoscopic perforations. A retrospective review of cases from a database of surgical complications was searched for perforations postcolonoscopy from January 1, 2001, to December 31, 2010 at a 527-bed community teaching hospital. Eighteen patients were identified, 11 of whom underwent examination at our institution. Ages ranged from 40 to 91 years with a mean age of 71 years. Eleven of the 18 patients were female and seven were male. Main outcome measures were treatment approach, treatment complications, and mortality. A total of 18 patients were identified in this database. Of these 18 patients, 11 underwent colonoscopy at our institution. During the studied time period, 7578 colonoscopies were performed at our hospital. The majority of the perforations were located in the rectosigmoid colon. Seventeen patients were treated with surgical exploration of the abdomen. Ten patients experienced complications postoperatively. There were two deaths in our series. Only cases in which the colonoscopy was performed at our institution were used when making incidence calculations. The incidence of perforation in our series was significantly higher than previously reported rates. When the perforation was discovered and treated within 24 hours, the patient was rescued. Timely recognition of surgical complications is critical in preventing patient mortality.