Experience in Iatrogenic Colonic Perforation Caused by Colonoscopy: A Review of 26,729 Colonoscopic Procedures

大腸鏡造成穿孔之經驗：回顧26,729個病人

溫家政(Chia-Cheng Wen) ； 溫淑惠(Shu-Hui Wen) ； 李才宇(Tsai-Yu Lee) ； 吳昌杰(Chang-Chieh Wu) ； 饒樹文(Shu-Wen Jao) ； 蕭正文(Cheng-Wen Hsiao)

《中華民國大腸直腸外科醫學會雜誌》 20卷2期 (2009/06) Pp. 32-38

https://doi.org/10.6312/SCRSTW.2009.20(2).09803

摘要

Purpose. The incidence of iatrogenic perforation caused by colonoscopic procedures is low. However, the rising number of procedures may pose problems. Our study aimed to clarify the perforation frequency in our hospital and to propose an appropriate treatment protocol for patients with perforation.
Methods. A retrospective study of patient records was performed for all patients with iatrogenic colonic perforation caused by colonoscopy between January 2001 and December 2007 in Tri-Service General Hospital, Taipei, Taiwan. The patients' demographic data, clinical characteristics, management and result were recorded. Fisher's exact and Wilcoxon rank-sum tests were used for statistical analysis.
Results. During these seven years, 26,729 colonoscopic procedures were performed and 10 iatrogenic colonic perforations occurred (0.037%). One patient recovered uneventfully with conservative treatment. Nine patients underwent a laparotomy. The postoperative course was uncomplicated in five cases and complicated in four. Eight perforations occurred in the sigmoid colon, one in the transverse colon and one in an unknown perforation site. In addition, the sepsis rate and mortality tended to be worse in cases with poor preparation of the colon, but these trends were not statistically significant. The hospital stay was prolonged significantly in patients with postoperative complications.
Conclusions. Iatrogenic colonic perforation during colonoscopy is a rare but serious complication. The sigmoid colon is the most common perforation site. Immediate operative management appears to be a good strategy for most patients.

關鍵字

大腸鏡 ； 穿孔 ； 大腸

並列摘要

Purpose. The incidence of iatrogenic perforation caused by colonoscopic procedures is low. However, the rising number of procedures may pose problems. Our study aimed to clarify the perforation frequency in our hospital and to propose an appropriate treatment protocol for patients with perforation.
Methods. A retrospective study of patient records was performed for all patients with iatrogenic colonic perforation caused by colonoscopy between January 2001 and December 2007 in Tri-Service General Hospital, Taipei, Taiwan. The patients' demographic data, clinical characteristics, management and result were recorded. Fisher's exact and Wilcoxon rank-sum tests were used for statistical analysis.
Results. During these seven years, 26,729 colonoscopic procedures were performed and 10 iatrogenic colonic perforations occurred (0.037%). One patient recovered uneventfully with conservative treatment. Nine patients underwent a laparotomy. The postoperative course was uncomplicated in five cases and complicated in four. Eight perforations occurred in the sigmoid colon, one in the transverse colon and one in an unknown perforation site. In addition, the sepsis rate and mortality tended to be worse in cases with poor preparation of the colon, but these trends were not statistically significant. The hospital stay was prolonged significantly in patients with postoperative complications.
Conclusions. Iatrogenic colonic perforation during colonoscopy is a rare but serious complication. The sigmoid colon is the most common perforation site. Immediate operative management appears to be a good strategy for most patients.

並列關鍵字

Colonoscopy ； Perforation ； Colon