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Surgical Endoscopy
Erschienen in: Surgical Endoscopy 12/2019

26.08.2019 | Review Article

Management of colonoscopic perforation: a systematic review and treatment algorithm

verfasst von: Khalid N. Alsowaina, Mooyad A. Ahmed, Nawar A. Alkhamesi, Ahmad I. Elnahas, Jeffrey D. Hawel, Nitin V. Khanna, Christopher M. Schlachta

Erschienen in: Surgical Endoscopy | Ausgabe 12/2019

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Abstract

Background

The aim of this review is to evaluate and summarize the current strategies used in the management of colonoscopic perforations as well as propose a modern treatment algorithm.

Methods

Articles published between January 2004 and January 2019 were screened. A total of 167 reports were identified in combined literature search, of which 61 articles were selected after exclusion of duplicate and unrelated articles. Only studies that reported on the management of endoscopic perforation in an adult population were retrieved for review. Case reports and case series of 8 patients or less were not considered. Ultimately, 19 articles were considered eligible for review.

Results

A total of 744 cases of colonoscopic perforations were reported in 19 major articles. The cause of perforation was mentioned in 16 articles. Colonoscopic perforations were reported as a consequence of diagnostic colonoscopies in 222 cases and therapeutic colonoscopies in 248 cases. The site of perforation was mentioned in 486 cases. Sigmoid colon was the predominant site followed by the cecum. The management of colonoscopic perforations was reported in a total of 741 patients. Surgical intervention was employed in 75% of the patients, of these 15% were laparoscopic and 85% required laparotomy. The predominant surgical intervention was primary repair.

Conclusion

Management strategies of colon perforations depend upon the etiology, size, severity, location, available expertise, and general health status. Usually, peritonitis, sepsis, or hemodynamic compromise requires immediate surgical management. Endoscopic techniques are under continuous evolution. Newer developments have offered high success rate with least amount of post-procedure complications. However, there is a need for further studies to compare the newer endoscopic techniques in terms of success rate, cost, complications, and the affected part of colon.
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Metadaten
Titel
Management of colonoscopic perforation: a systematic review and treatment algorithm
verfasst von
Khalid N. Alsowaina
Mooyad A. Ahmed
Nawar A. Alkhamesi
Ahmad I. Elnahas
Jeffrey D. Hawel
Nitin V. Khanna
Christopher M. Schlachta
Publikationsdatum
26.08.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 12/2019
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07064-7

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