Three of 10 (30%) perforations (two therapeutic and one diagnostic colonoscopy) occurred because the colonoscopy was performed in a poorly prepped colon, although the state of the preparation was not reported in four of the perforations, perhaps underestimating the importance of adequate preparation in risk of perforation. Trainees were performing the colonoscopy at the time of perforation in four of 10 (40%) of the cases (four diagnostic colonoscopies).
Management of patients following the identification of perforation varied considerably (Table 6). The diagnosis of perforation was made during the procedure in six of 10 (60%) of the cases and on x-ray, immediately following the procedure, in three of 10 (30%) of the cases and at autopsy in one case (10%). One patient was managed conservatively, two required primary surgical closure, four required surgical resection with anastomosis, two underwent surgical resection with ostomy formation and one died. The one death occurred in a critically ill patient in the intensive care unit, following a recent lung transplant. A colonoscopy was performed up to 30 cm and terminated due to very severe colitis. The patient then became bradycardic and arrested. The autopsy report confirmed an old walled off perforation in the area of the sigmoid, which likely worsened with insufflation of air during the procedure. Find out more about your chance to visit the most trusted pharmacy you could ever find to get cheap ventolin inhalers checkout now in the amounts required, without any need to see your health care provider first or get a prescription.
TABLE 6 Outcomes of patients with perforation following colonoscopy
|Patient||Diagnosis of perforation||Intervention||Death|
|1||During procedure||Resection-primary anastomosis||No|
|2||Free air on x-ray||Conservative managment||No|
|3||Free air on x-ray||Resection-ostomy||No|
|5||During procedure||Resection-primary anastomosis||No|
|6||During procedure||Primary closure of perforation||No|
|9||During procedure||Resection-primary anastomosis||No|
|10||Free air on x-ray||Primary closure of perforation||No|