Clin Endosc.  2013 Sep;46(5):495-499.

Colonic Perforation: Can We Manage It Endoscopically?

• Byeon JS

Abstract

Colonic perforation occurs in a variety of clinical scenarios and colonoscopy-associated perforation is one of the important reasons for colonic perforation. Colonoscopy-associated perforation may be diagnosed during colonoscopy procedure by the visualization of evident colonic wall defect or, after the completion of colonoscopy, by the visualization of leaked air in the peritoneal or retroperitoneal space. Recently, the incidence of colonoscopy-associated perforation increased because of the introduction of colorectal endoscopic submucosal dissection. Traditionally, colonoscopy-associated perforation was managed surgically. However, medical management has been introduced widely and endoscopic clipping is the most important component for the medical management of colonoscopy-associated perforation. Timely administration of antibiotics is also important. Large perforations, diagnostic colonoscopy-associated perforations, large amount of pneumoperitoneum, and severe abdominal pain have been reported to be predictive of the necessity of surgery after endoscopic clipping. Surgery should be performed if patients show clinical deterioration even after the initiation of medical management.

Keyword

Perforation; Colonoscopy; Surgical instruments; Endoscopy; Colon

MeSH Terms

Abdominal Pain
Anti-Bacterial Agents
Colon
Colonoscopy
Endoscopy
Humans
Incidence
Pneumoperitoneum
Retroperitoneal Space
Surgical Instruments
Anti-Bacterial Agents

Figure

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  Fig. 1 Endoscopically proven perforation. (A) Diagnostic colonoscopy-associated perforation. The perforation occurred during excessive pushing of the colonoscope. It is relatively large. (B) Therapeutic colonoscopy-associated perforation. The perforation developed during endoscopic submucosal dissection (ESD) of colonic adenoma. It is relatively small and the surrounding area shows ESD ulcer.

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  Fig. 2 Radiologically proven perforation. (A) An endoscopic submucosal dissection (ESD) ulcer shows no definite evidence of endoscopically proven perforation. (B) Follow-up X-ray taken right after the completion of ESD shows a large amount of pneumoperitoneum, which means the presence of microperforation at the ESD ulcer bed.

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  Fig. 3 Endoscopic clipping. (A) A mural defect developed after endoscopic mucosal resection of colon polyp. (B) Five clips were applied and the perforation was closed completely.

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