Colonoscopic Perforation Management by Laparoendoscopy: An Algorithm

Makarawo, Tafadzwa; Damadi, Amir; Mittal, Vijay K.; Itawi, Ed A.; Rana, Gurteshwar

doi:10.4293/108680813x13693422518759

Cited by 18 publications

(10 citation statements)

References 26 publications

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“…Operative management is determined by the intra‐operative findings. Factors to consider include size and location of perforation, quality of the bowel preparation and extent of contamination as well as compromise to the mesentery . Review of previous studies reveal between 50% and 100% of patients with colonoscopic perforation undergo urgent laparotomy, with estimated morbidity rates of 34% and mortality rates of 25% …”

Section: Discussionmentioning

confidence: 99%

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Chew

Faragher

2019

ANZ Journal of Surgery

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Background: The use of colonoscopy has been increasing in Australia. This case series describes management and outcomes of colonoscopic perforation managed by a single tertiary referral unit. Methods: An analysis of 13 years (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) of prospectively collected data on patients who had a colonoscopic perforation and were managed by the colorectal unit at a single tertiary referral centre was performed. Main outcomes were time of diagnosis, modality of management, time to theatre, length of stay, cost of admission and complications. Results: Sixty-two patients had perforations (median age of 69 years). Thirty-eight (61.2%) patients had their colonoscopy performed in another institution. The incidence rate decreased to 0.37 perforations per 1000 colonoscopies within Western Health. Overall, diagnostic colonoscopies accounted for 56% of perforations and perforations were likely to occur in the left colon (P = 0.006). Fifty-one (82%) patients underwent surgery during their admission, with 24% of these being laparoscopic procedures. An earlier diagnosis was associated with significantly less intra-abdominal contamination. Gross peritoneal contamination was more likely to be associated with the decision to form a stoma (37%, n = 19, P = 0.04). Thirty-day mortality was 1.6% (n = 1). Conclusions: Colonoscopic perforations occur in experienced hands and may have serious implications. We demonstrated a difference in patterns of injury between therapeutic and diagnostic colonoscopies. Those who have an earlier diagnosis are less likely to have severe intra-abdominal contamination requiring a stoma formation.

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Section: Discussionmentioning

confidence: 99%

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Chew

Faragher

2019

ANZ Journal of Surgery

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“… 2 Recent reports have proven the safety and efficacy of laparoscopic approaches to colonoscopic perforation. 9 - 11 Endoscopic clip closure of an immediately recognized perforation may prevent the need for surgical repair 12 ; however, clinical deterioration after clip repair and medical management necessitates immediately referral for surgery. 13 …”

Section: Discussionmentioning

confidence: 99%

Perforation of a Long-standing Ileocolonic Anastomosis During Colonoscopy

Tofani

Phillips

McCue

et al. 2015

ACG Case Reports Journal

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Colonoscopy is a valuable diagnostic and therapeutic procedure. Colonic perforation is a serious complication of colonoscopy that must be promptly recognized to limit morbidity and mortality. We present a 69-year-old woman who, during colonoscopy, had a perforation secondary to barotrauma of a long-standing ileocolonic anastomosis proximal to the point of colonoscopic intubation. To our knowledge, this is the first case report of a perforation of a well-established anastomosis proximal to the point of endoscope intubation during colonoscopy.

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“…Recent reports suggest that laparoscopy is a safe and effective alternative to laparotomy in a subset of patients with colonoscopic perforation. 27,28 The principles of repair should be the same as for open surgery. In a recently published series of laparoscopic repair, primary repair was preferred in well-vascularized tissues when approximation of the edges of perforation could be performed without tension and did not lead to narrowing of the lumen.…”

Section: Operative Managementmentioning

confidence: 99%

“…Finally, in cases with significant intraperitoneal contamination or injuries of the low rectum, staged repair was performed. 27 One study has postulated that laparoscopic repair has the potential to reduce medico-legal actions, as it is less traumatic than a laparotomy and recovery is expedited. 28 Laparoscopy is contraindicated in hemodynamically unstable patients.…”

Section: Operative Managementmentioning

confidence: 99%

Colonoscopic Perforations

Rai

Mishra

2017

Clinics in Colon and Rectal Surgery

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Colonoscopy is the gold standard for colon cancer screening. It has led to a decrease in the incidence of colorectal cancer mortality. Colon perforation is a feared complication of this procedure with high morbidity and substantial mortality. Due to the high volume of colonoscopies performed, the absolute number of colonoscopic perforations is relatively high. It leads to a substantial cost to the patient and the health system. Understanding the mechanisms and the risk factors may help in preventing perforation. Traditionally, a laparotomy with creation of a stoma was used to address this complication. However, minimally invasive techniques such as laparoscopy and endoluminal repairs are being used more commonly now. More surgeons are favoring primary anastomosis (with or without a diverting loop ileostomy) than a Hartmann procedure.

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Colonoscopic Perforation Management by Laparoendoscopy: An Algorithm

Abstract: Laparoscopic intervention may be a safe and effective alternative to open surgery for management of perforation during colonoscopic examination. A simple algorithm is presented that may be helpful for those considering a laparoscopic approach to managing this condition.

Cited by 18 publications

References 26 publications

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Perforation of a Long-standing Ileocolonic Anastomosis During Colonoscopy

Colonoscopic Perforations

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