Colonoscopic Perforations

Abstract

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.

Adverse events related to colonoscopy: Global trends and future challenges

“…To date, diverse risk factors for colonoscopic perforation and bleeding have been identified. Patient-related factors (old age, female gender, multiple comorbidities, large polyps) and the need for additional intervention such as polypectomy are among these risk factors[14,16]. Three studies have evaluated the risk factors for post-colonoscopy bleeding[5,8,9], which are listed in Table 6.…”

“…It happens very rarely, but it is a feared adverse event with high morbidity and considerable mortality[12,13]. Generally, colonoscopy perforation was defined as intraperitoneal fat or viscera seen during the colonoscopy, or the presence of radiographic abnormalities (intra-abdominal free air on X-rays, or localized or diffuse release of gas or intestinal fluid into the peritoneum on computed tomography (CT) scans)[5,9,14]. Colonoscopy perforations may occur by several mechanisms, such as mechanical trauma, barotrauma, thermal energy and removal of a tissue lesion[14].…”

“…Generally, colonoscopy perforation was defined as intraperitoneal fat or viscera seen during the colonoscopy, or the presence of radiographic abnormalities (intra-abdominal free air on X-rays, or localized or diffuse release of gas or intestinal fluid into the peritoneum on computed tomography (CT) scans)[5,9,14]. Colonoscopy perforations may occur by several mechanisms, such as mechanical trauma, barotrauma, thermal energy and removal of a tissue lesion[14]. Iqbal et al[13] classified the injury characteristics, based on the mechanism of perforation, into thermal, polypectomy and blunt.…”

Perforasi Kolon pada Kanker Kolon

“…Perforasi pada daerah jaringan yang diangkat dengan prosedur polipektomi akibat prosedur mekanis saat penggunaan instrumen biopsi yang tidak tepat, selain itu perforasi juga dapat terjadi karena dilatasi dari striktur atau penempatan stent. Perforasi akibat kolonoskopi yang ditemukan pada kolon sigmoid sebagai tempat perforasi yang paling sering terjadi, diikuti dengan sekum, kolon asendens dan tranversum dan sisanya di kolon desendens (Rai & Mishra, 2018).…”

“…Faktor risiko yang dapat menyebabkan terjadinya perforasi pada kanker kolon yaitu tindakan kolonoskopi yang merupakan standar baku untuk skrining adanya kanker kolon yang berhubungan dengan perforasi iatrogenik atau akibat adanya trauma mekanis dari tindakan. Terjadinya obstruksi sebagai indikasi dilakukannya kolonoskopi juga menjadi faktor risiko terjadinya perforasi (Rai & Mishra, 2018).…”