Clinical treatment in colonoscopic perforation: a comparison of surgical and conservative management

Abstract

Background: Successful management of colonoscopic perforation by conservative treatment has been reported, but management remains controversial. Delayed surgery in some situations may lead to an irretrievable result. How to make the best decision? A retrospective study was designed to address this challenge.

Methods: From the period October 1982 and December 1995, 9214 consecutive colonoscopic examinations at Taichung Veterans General Hospital were reviewed.

Results: Twenty perforations (0.22%) related to the procedure were found. Of those 16 occurred during diagnostic colonoscopies, and four, during therapeutic colonoscopies. Fifteen perforations caused by diagnostic colonoscopies were treated by surgery, one perforation caused by diagnostic colonoscopy and the four by therapeutic colonoscopies were treated by non-surgical methods.

Conclusions: A standard text on large bowel surgery recommends laparotomy for most cases of colonoscopic perforations. In experience here, however, non-operative management was indicated if the perforation was small with no signs of general peritonitis, and the patient's condition was good. However, if the patients deteriorated with non-operative treatment, immediate laparotomy is indicated.