Korean Journal of Gastrointestinal Endoscopy 2009;38(1): 9-13.
대장내시경에 의한 대장천공의 고찰
서정혁ㆍ김진승ㆍ이광찬ㆍ고진철
성애병원 외과
Colonoscopic Perforations: 4 Years' Experience
Jung Hyuk Suh, M.D., Chin Seung Kim, M.D., Kwang Chan Lee, M.D. and Jin Chul Ko, M.D.
Department of Surgery, Sung Ae Hospital, Seoul, Korea
Abstract
Background/Aims: Many physicians agree that colonoscopy is the best modality for either the diagnostic evaluation or use in therapy for colorectal disease. Although the incidence of perforations that occur after colonoscopy is low, the increasing number of performed colonoscopies may pose a relevant health problem with including the often lethal consequences. This study aimed to determine the frequency of perforation and the management of colonoscopic perforation. Modern Korean society has adopted westernized dietary habits, and this has led to an increased incidence of colorectal disease such as colorectal cancer, polyps and diverticulosis.
Methods: We conducted a retrospective review of the medical records of all the patients who underwent colonoscopy complicated by colon perforation between January 2004 and December 2007. The patients' demographics, the purpose of colonoscopy, the location of the perforation, the management and the outcome were compared.
Results: A total of 5254 patients underwent either a diagnostic or therapeutic colonoscopy procedure during four consecutive years at a single institution. Iatrogenic colonoscopic perforations (0.2%) were diagnosed in 11 patients (seven males and four females). Perforations occurred in six patients during a diagnostic colonoscopy and these occurred in five patients during a therapeutic colonoscopy. Free air in the peritoneum or retroperitoneum was seen in all the patients, as depicted on plain X-rays. Seven patients were treated with surgical intervention and four patients were treated with conservative management. One of the 11 patients with a perforation expired on postoperative day 47 due to infective endocarditis.
Conclusions: The rate of iatrogenic colonoscopic perforation is still very low. Although perforation is a very serious complication and it can be a lethal malady, early recognition and treatment are very critical factors to optimize the patient outcome. Although a gold standard therapeutic modality has not been established, the patients who present with the signs and symptoms of generalized peritonitis are recommended to undergo early surgical intervention. (Korean J Gastrointest Endosc 2009;38:9-13)
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