COLONIC PERFORATION DUE TO COLONOSCOPY - A RETROSPECTIVE STUDY OF 48 CASES

Background and Study aims: The aim of this retrospective study was to analyze data on the treatment of 48 cases of colonic perforation, with a view to defining the criteria for choosing between medical and surg ical treatment, Patients and Methods: A questionnaire requesting infor mation about complications of colonoscopy and their treatment was sent out to four hospital gastroenterological and surgical units, Results: From January 1979 to December 1993, we reviewed the records of 48 cas es of colonic perforation following colonoscopy (24 perforations occur red after diagnostic colonoscopy and 24 after therapeutic colonoscopy) , Diagnosis of perforation was delayed in 42% of the patients, with a mean delay of two days (range 0.5-7 days), The treatment was surgical in 35 cases, including eight in which previous medical treatment had b een unsuccessful, The perforation was in the sigmoid colon in 74% of t he surgical population, Operations were carried out using two procedur es, including colostomy, in the case of 20 patients (57%), Colostomy c losure was performed in 12 patients (60%) with no mortalities, Surgica l mortality occurred in five patients (14%), in four cases due to pree xisting medical diseases, Medical treatment was attempted in 21 cases, and was successful in 13, mainly in cases in which perforation had oc curred after therapeutic colonoscopy (12 patients), Conclusion: The ch oice of the right type of treatment for colonoscopic perforation seems to depend on the size of the lesion, Surgical treatment is appropriat e when the perforation has occurred during diagnostic colonoscopy, sin ce the lesion in this case is usually a large colonic laceration, wher eas nonsurgical treatment seems to be justified after polypectomy, as long as there is rapid clinical improvement.