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Surgical Management of Iatrogenic Perforation of the Gastrointestinal Tract: 15 Years of Experience in a Single Center

World Journal of Surgery volume 41, pages 1961–1965 (2017)Cite this article

Abstract

Background

Gastrointestinal (GI) tract perforation during endoscopy is a rare but severe complication. The aim of this study was to determine predictors of morbidity and mortality after iatrogenic endoscopic perforation.

Materials and methods

All cases with iatrogenic endoscopic perforation receiving surgery at a tertiary referral center in a 15-year period (2000–2015) were retrospectively analyzed. Demographics, type of endoscopy, site of perforation, operative procedure, morbidity and mortality were analyzed. Multiple logistic regression was used to identify parameters predicting survival.

Results

A total of 106.492 endoscopies were performed, and 82 (0.08%) patients were diagnosed with GI perforation. Most perforations (63.4%) occurred in the lower GI tract, compared to 36.6% in the upper GI tract. In 21 cases (25%), perforation was noticed during endoscopy, whereas 61 perforations (75%) were diagnosed during the further clinical course. Operative care was applied within 24 h in 61%. Surgery of perforations was almost completely performed maintaining the intestinal continuity (68%), whereas diversion was performed in 32%. Mortality was associated with age above 70 (OR 4.89, p = 0.027), ASA class > 3 (OR 4.08, p = 0.018), delayed surgery later than 24 h after perforation (OR 5.9, p = 0.015), peritonitis/mediastinitis intraoperatively (OR 4.68, p = 0.031) and severe postoperative complications with a Clavien–Dindo grade ≥III (OR 5.12, p = 0.023).

Conclusion

The prevalence of iatrogenic endoscopic perforation is low, although it is associated with a serious impact on morbidity and mortality. Delayed management worsens prognosis. To achieve successful management of endoscopic perforations, early diagnosis is essential in cases of deviation from the normal post-interventional course, especially in elderly.

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Affiliations

  1. Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Christoph Holmer, Christoph A. Mallmann, Marlis A. Musch, Martin E. Kreis & Jörn Gröne

  2. Department of General and Visceral Surgery, Rotes Kreuz Krankenhaus, Bremen, Germany

    Jörn Gröne

Authors
  1. Christoph Holmer
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  2. Christoph A. Mallmann
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  3. Marlis A. Musch
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  4. Martin E. Kreis
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Correspondence to Christoph Holmer.

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C. Holmer and other co-authors have no conflict of interest.

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Holmer, C., Mallmann, C.A., Musch, M.A. et al. Surgical Management of Iatrogenic Perforation of the Gastrointestinal Tract: 15 Years of Experience in a Single Center. World J Surg 41, 1961–1965 (2017). https://doi.org/10.1007/s00268-017-3986-7

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  • DOI: https://doi.org/10.1007/s00268-017-3986-7

Keywords

  • Endoscopic Procedure
  • Abdominal Compartment Syndrome
  • Esophageal Perforation
  • Gastrointestinal Perforation
  • Dindo Classification