Abstract
In a 10-year experience with 4,784 consecutive colonoscopic polypectomies, the need for operative intervention in just two of seven perforations indicates that patients with specially defined, limited perforations can usually be treated nonoperatively. This specific complication, which has been termed “mini-perforation,” is generally detected within 6–24 hours of polypectomy, and is characterized by local pain and tenderness, without signs of diffuse or spreading peritoneal irritation. Free intra-abdominal or retroperitoneal air on x-ray documents the actual perforation. Complete resolution of symptoms within 24–48 hours confirms the diagnosis of “mini-perforation. ” Success depends on good bowel preparation for colonoscopy, and early recognition of perforation, with institution of bowel rest and intravenous antibiotics. The “mini-perforation” spontaneously closes, probably by omental adherence. Frequent serial clinical examinations are mandatory so that frank perforation with advancing peritonitis will be promptly recognized and treated surgically. An understanding of the three levels of cautery injury to the colon wall—“serosal burn,” “mini-perforation, ” and “frank perforation” are essential in managing the complications of colonoscopic polypectomy.
Similar content being viewed by others
References
Shinya H. Colonoscopy: diagnosis and treatment of colonic diseases. New York: Igaku-Shoin, 1982.
Nivatvongs S. Complications in colonoscopic polypectomy: an experience with 1,555 polypectomies, Dis Colon Rectum 1987;29:825–30.
Christie JP, Shinya H. Technique of colonoscopic polypectomy. Surg Clin North Am 1982;62:877–87.
Carpio G, Alber E, Gumbs MA, Gerst PH. Management of colonic perforation after colonoscopy. Dis Colon Rectum 1989;32:624–6.
Christie JP. Colonoscopic excision of sessile polyps. Am J Gastroenterol 1976;66:23–8.
Christie JP. Colonoscopic excision of large sessile polyps. Am J Gastroenterol 1977;67:430–8.
Author information
Authors and Affiliations
Additional information
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29–May 4, 1990.
About this article
Cite this article
Christie, J.P., Marrazzo, J. “Mini-perforation” of the colon—Not all postpolypectomy perforations require laparotomy. Dis Colon Rectum 34, 132–135 (1991). https://doi.org/10.1007/BF02049986
Issue Date:
DOI: https://doi.org/10.1007/BF02049986