A Case of Post-Colonoscopy Cecal Perforation in a 78-Year-Old Man Responding to Conservative Management

Abstract

Since the 1960s, colonoscopy has been the most extensively utilized diagnostic technique for colorectal cancer, and it is also a treatment tool for several colorectal diseases. Like many other medical treatments, it has complications, some of which might pose a major threat to the patient's health and wellbeing if not detected early enough. There is no consensus on the best way to treat colonoscopic perforation, and the majority of cases need immediate surgery. However, iatrogenic colon perforation can sometimes be treated conservatively. In this report, we describe a case of post-colonoscopic cecal perforation that was managed conservatively.

Case Series: Management and outcomes of two cases of colonic perforation following colonoscopy

“…Colonoscopy, a commonly performed procedure and the primary diagnostic tool for colorectal cancer, also plays a role in managing specific colorectal conditions, despite its relative safety, it does entail potential complications including colonic perforation, gastrointestinal bleeding, injury to intra-abdominal organs, and cardiopulmonary instability. 6 Although rare, Iatrogenic perforation carries a significant risk of morbidity and mortality. 7 The optimal management approach involves a collaborative effort among endoscopists, radiologists, and surgeons, requiring their prompt availability.…”

“…The incidence of colonic perforation varies between diagnostic and therapeutic colonoscopies, 8,9 with both sharing similar mechanisms such as mechanical injuries or barotrauma, but therapeutic colonoscopy presenting an additional potential risk of perforation, 10 resulting in an incidence ranging from 0.03% to 0.8% for diagnostic colonoscopy and 0.15% to 3% for therapeutic colonoscopy. 6 During diagnostic procedures, iatrogenic perforations are most frequently observed in the sigmoid colon and the rectosigmoid junction. This occurs because of direct mechanical injury caused by the shearing forces exerted by the colonoscope's shaft or tip during insertion.…”

“…Regarding frequency, the sigmoid colon is the most commonly affected site in iatrogenic colonic perforation cases (53-64%), followed by the cecum (14-24%) and the ascending colon (24%), with notably lower incidences in the transverse colon, descending colon, and rectum. 6 Colonic perforations can be categorized into three types: intraperitoneal (the most prevalent scenario), extraperitoneal, or a combination of both. 6 The distribution of free air within distinct anatomical regions leads to the manifestation of symptoms and clinical signs, which depend on the type of perforation.…”

“…6 Colonic perforations can be categorized into three types: intraperitoneal (the most prevalent scenario), extraperitoneal, or a combination of both. 6 The distribution of free air within distinct anatomical regions leads to the manifestation of symptoms and clinical signs, which depend on the type of perforation. 13 Typically, colonic perforation presents with acute abdominal pain, sometimes accompanied by fever.…”