In this large single-center study, the perforation rate was 0.07%, and nearly all patients with perforations were treated operatively.
Risk for colonic perforation is an important part of the benefit-harm calculation for colonoscopy, particularly for asymptomatic people who are undergoing the procedure solely for cancer screening. In this report, Mayo Clinic researchers describe their institutional experience with colonoscopic perforation.
Between 1980 and 2006, 180 perforations occurred during 258,248 colonoscopies (incidence, 0.07%; 1 perforation per 1435 procedures). Cancer screening was the indication for colonoscopy in about half the perforation cases. Blunt injury, polypectomy, and thermal injury (e.g., from electrocautery) were the causes of perforation in 55%, 27%, and 18% of cases, respectively.
Fifteen cases were managed nonoperatively, and 165 were managed operatively. Twenty-three percent of perforations were recognized at the time of colonoscopy, 54% of patients had perforations that were recognized within 24 hours (but after their procedures), and 22% of patients presented beyond 24 hours. The incidence of postoperative complications (e.g., cardiac, pulmonary, infectious) was 36%, and the mortality rate was 7%.
Comment: The incidence of colonoscopic perforation in this cohort was similar to those reported in other studies; the risk is low but certainly not trivial. These authors argue for operative management in most cases but note that selected patients without evidence of peritonitis can be managed nonsurgically.
— Allan S. Brett, MD
Published in Journal Watch General Medicine August 14, 2008
Iqbal CW et al. Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 2008 Jul; 143:701.