Abstract
Background
Iatrogenic colon perforation (ICP) due to colonoscopy is a severe complication and is associated with significant morbidity and mortality. The global estimated incidence of ICP is 0.03% and up to 3% for diagnostic and therapeutic colonoscopies, respectively. Treatment options include endoscopic repair, conservative therapy, and surgery. Treatment decision is based on the time and the setting of the diagnosis, the type, and location of the perforation, the presence of related pathologies, the clinical status and characteristic of the patient, and surgeon’s skills. We present our experience in the treatment of ICPs.
Methods
A retrospective review was undertaken of all patients suffering from ICP at Bnai-Zion Medical Center between 1/1/2010 and 1/3/2021. Clinical presentation, therapeutic approach, and short-term outcomes were analyzed.
Results
There were 51 cases of ICPs. Fourteen (27%) were diagnosed by the gastroenterologist during the procedure, 2 of whom were treated with endoscopic clips. The rest of the patients (72.5%) were diagnosed in the ER after a CT scan. Forty-three patients (84%) went on to operative management: 5 (11%) operations started with laparotomy—all were conducted in the early study period (until 2013). All other operations (88%) started with a diagnostic laparoscopy, 4 of whom (10%) were converted to laparotomy. Out of the 38 laparoscopic cases 29 (80%) were treated with primary suturing. Seven patients went on to colon resection (5 of whom with primary anastomosis). Six patients required ICU admission—with 1/38 (2%) from the laparoscopic cases, and 5/9 (55%) from the laparotomy cases. A total of 49/51 (96%) patients recovered and were discharged after 5 ± 2 for conservative and laparoscopic cases, and 12 ± 9 for open cases.
Conclusion
Laparoscopic treatment of ICP is safe and feasible in most cases. Our data supports a laparoscopic attempt at any such scenario.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Data availability
The experimental data and the simulation results that support the findings of this study are available in Figshare with the identifier https://doi.org/10.6084/m9.figshare.23984067.
References
Nicola D et al (2018) 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World Journal of Emergency Surgery 13(1) BioMed Central Ltd. https://doi.org/10.1186/s13017-018-0162-9
Zhong W et al (2016) Efficacy of laparoscopic primary repair in the treatment of colonic perforation after colonoscopy: a review of 40,127 Patients. [Online]. Available: www.surgical-laparoscopy.com
Hassan C, Rex DK, Zullo A, Kaminski MF (2015) Efficacy and cost-effectiveness of screening colonoscopy according to the adenoma detection rate. United European Gastroenterol J 3(2). https://doi.org/10.1177/2050640614565199
Niv Y, Gershtansky Y, Kenett RS, Tal Y, Birkenfeld S (2011) Complications in colonoscopy: analysis of 7-year physician-reported adverse events. Eur J Gastroenterol Hepatol 23(6). https://doi.org/10.1097/MEG.0b013e32834702ab
Church J (2013) Complications of colonoscopy. Gastroenterol Clin North Am 42(3). https://doi.org/10.1016/j.gtc.2013.05.003
Makarawo TP, Damadi A, Mittal VK, Itawi E, Rana G (2014) Colonoscopic perforation management by laparoendoscopy: an algorithm. J Soc Laparoendosc Surg 18(1):20–27. https://doi.org/10.4293/108680813X13693422518759
Damore LJ, Rantis PC, Vernava AM, Longo WE (1996) Colonoscopic perforations: etiology, diagnosis, and management. Dis Colon Rectum 39(11). https://doi.org/10.1007/BF02055129
Rotholtz NA, Laporte M, Lencinas S, Bun M, Canelas A, Mezzadri N (2010) Laparoscopic approach to colonic perforation due to colonoscopy. World J Surg 34(8). https://doi.org/10.1007/s00268-010-0545-x
Coimbra C et al (2011) Laparoscopic repair of colonoscopic perforation: a new standard?. Surg Endosc 25(5). https://doi.org/10.1007/s00464-010-1427-x
Alsowaina KN et al (2019) Management of colonoscopic perforation: a systematic review and treatment algorithm. Surg Endosc 33(12). https://doi.org/10.1007/s00464-019-07064-7
Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143(7). https://doi.org/10.1001/archsurg.143.7.701
Kim J, Lee GJ, Baek JH, Lee WS (2014) Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy. Ann Surg Treat Res 87(3). https://doi.org/10.4174/astr.2014.87.3.139
Rumstadt B, Schilling D, Sturm J (2008) The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech 18(6). https://doi.org/10.1097/SLE.0b013e318182b025
Avgerinos DV, Llaguna OH, Lo AY, Leitman IM (2008) Evolving management of colonoscopic perforations. J Gastrointest Surg 12(10). https://doi.org/10.1007/s11605-008-0631-7
Nho RL, Mege D, Ouaïssi M, Sielezneff I, Sastre B (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149(5). https://doi.org/10.1016/j.jviscsurg.2012.05.004
Hawkins AT, Sharp KW, Ford MM, Muldoon RL, Hopkins MB, Geiger TM (2018) Management of colonoscopic perforations: a systematic review. Am J Surg 215(4). https://doi.org/10.1016/j.amjsurg.2017.08.012
Xu L-S, Zhai B (2016) Psycological trauma in the era of precise minimally invasive surgery. World Chin J Dig 24(17):2637. https://doi.org/10.11569/wcjd.v24.i17.2637
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Boaz Loberman and Gideon Sroka. The first draft of the manuscript was written by Boaz Loberman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Loberman, B., Kuhnreich, E., Matter, I. et al. Laparoscopic management of iatrogenic colon perforation. Int J Colorectal Dis 38, 259 (2023). https://doi.org/10.1007/s00384-023-04550-2
Accepted:
Published:
DOI: https://doi.org/10.1007/s00384-023-04550-2