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Surgical management and outcomes of 165 colonoscopic perforations from a single institution Iqbal CW; Cullinane DC; Schiller HJ; Sawyer MD; Zietlow SP; Farley DRArch Surg 2008[Jul]; 143 (7): 701-6; discussion 706-7BACKGROUND: Increasing use of colonoscopy is making iatrogenic perforations more common. We herein present our experience with operative management of colonoscopic-related perforations. DESIGN: Retrospective review (1980-2006). SETTING: Tertiary referral center. PATIENTS: A total of 258 248 colonoscopies performed in patients, from which we identified 180 iatrogenic perforations (incidence, 0.07%). Of these, 165 perforations were managed operatively. RESULTS: Patients underwent primary repair (29%), resection with primary anastomosis (33%), or fecal diversion (38%). Patients presenting within 24 hours (78%) were more likely to have minimal peritoneal contamination (64 patients [50%] vs 6 [17%]; P = .01) and to undergo primary repair or resection with anastomosis (86 [67%] patients vs 13 [36%]; P < .01). Patients presenting after 24 hours (22%) were more likely to have feculent contamination (16 patients [44%] vs 4 [11%]; P = .02) and to receive an ostomy (23 patients [64%] vs 43 [33%]; P = .02). The sigmoid colon was the most frequent site of perforation, followed by the cecum (53% and 24%, respectively; P < .001); blunt or torque injury exceeded polypectomy and thermal injuries (55% vs 27% and 18%, respectively; P < .001). Patients with blunt injuries were more likely to receive a stoma than were those with polypectomy and thermal perforations (44 patients vs 9 and 9, respectively; P = .02), as were patients with feculent peritonitis compared with those with moderate and minimal soilage (28 patients [78%] vs 28 [42%] and 6 [10%] respectively; P = .002). Operative morbidity was 36%, with a mortality rate of 7%. Multivariate analysis indicated that blunt injuries, poor bowel preparation, corticosteroid use, and being younger than 67 years were risk factors for postoperative morbidity (P |Aged[MESH]|Colonoscopy/*adverse effects/statistics & numerical data[MESH]|Humans[MESH]|Iatrogenic Disease[MESH]|Intestinal Perforation/etiology/*surgery[MESH]|Retrospective Studies[MESH]|Treatment Outcome[MESH] |
