CLINICAL PRESENTATION AND MANAGEMENT OF IATROGENIC COLON PERFORATIONS

BACKGROUND: Because iatrogenic colonic perforation is uncommon, surgic al management of this complication has been based on the civilian trau ma experience. In this study, we determine the incidence, clinical pre sentation, and management of colonic perforations resulting from colon oscopy or barium enema. PATIENTS AND METHODS: The medical records of a ll patients with colorectal perforations due to barium enema or colono scopy seen over a 5-year period were reviewed. RESULTS: Twenty-one pat ients, 12 males and 9 females aged 66 +/- 16 years, undergoing evaluat ion for polyps and bleeding (11), diverticulosis (4), diarrhea (2), or miscellaneous indications (4) sustained colonic perforation from colo noscopy (18; 0.20%) or barium enema (3; 0.10%). Abdominal pain, 66% (1 3), and fever, 24% (5), were the most frequent symptoms encountered an d extraluminal air, 67% (14), the most common radiologic finding. The site of perforation was the rectosigmoid in 62% (13) of patients. Eigh teen patients underwent surgery; 11 within 24 hours (group I) and 7 pa tients within 6.0 +/- 4 days (group II). Fifty percent (9 of 18) had p rimary repair or resection with anastomosis without mortality. Of the 6 patients initially treated nonoperatively, 3 subsequently underwent surgery. Both deaths, one in group I and one in group II, occurred in patients who had colonic diversion for perforation following colonosco py. CONCLUSION: We conclude that in the absence of significant contami nation either primary repair or resection and anastomosis can be perfo rmed with acceptable morbidity for iatrogenic perforations nf the colo n. (C) 1996 by Excerpta Medica, Inc.