Colonoscopic Perforation and Its Management at a Tertiary Care Hospital
Keywords:
Colonoscopic perforation, Risk factor, Management, MortalityAbstract
Introduction: Colonoscopy is a tool for screening colorectal cancer, but colonoscopic perforation (CP), though rare, is of concern, because of its high morbidity and mortality. The objective of the present study is to determine the incidence, risk factors, management, outcome, and mortality rate of CP at a tertiary care hospital.
Methods: The present retrospective study included patients who underwent colonoscopy from January 1, 2009, to January 1, 2020 at the authors’ institution. Management of patients with colonoscopic perforation were categorized into two groups according to therapeutic modality: the operative (surgery) and non-operative (endoscopic management or conservative treatment) groups.
Results: There were 71 patients with CP. Of these, 19 received endoscopic management. Endoscopic management failure occurred in 8 patients, and 60 patients underwent laparotomy after diagnosis. Segmental bowel resection with primary anastomosis was done in 37 patients. Leakage of anastomosis occurred in 3 patients. The average time to diagnosis was 9.73±16.87 hours (range, 1 to 96 hours), the average time to operation after diagnosis was 6.98±4.91 hours (range,1 to 24 hours). The mortality rate was 7%. Factors associated with mortality were time to diagnosis and type of operation (p=0.003 and p=0.012, respectively). The average hospital stay was 10.90 ± 7.96 days (range, 3 to 45 days).
Conclusion: The time to diagnosis and the injury mechanism are major factors in the choice of management. Nonoperative management is beneficial and feasible for colonoscopic perforation with early detection.
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