Critical decisions in the management of endoscopic perforations of the colon

The ideal management of suspected colon perforation following colonoscopy r emains elusive because the incidence is only 0.1 to 2.0 per cent. The patie nt with obvious perforation deserves immediate exploration, but the patient with equivocal findings poses a diagnostic dilemma. We propose an algorith m based on the results of water-soluble contrast enema that allows for rapi d, definitive surgical decision-making. If perforation is confirmed, early operation allows for primary repair without resection or colostomy, or if n o perforation is identified, medical management can be undertaken with conf idence. This algorithm should ensure that the surgical management of this p otentially lethal complication is not unnecessarily delayed.