Skip to main content
SpringerLink
Log in

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

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Paspatis GA, Dumonceau J-M, Barthet M, Meisner S, Repici A, Saunders BP et al (2014) Diagnosis and management of iatrogenic endoscopic perforations: European society of gastrointestinal endoscopy (ESGE) position statement. Endoscopy 46:693–711

    Article  PubMed  Google Scholar 

  2. Bielawska B, Day AG, Lieberman DA (2014) Risk factors for early colonoscopic perforation include non-gastroenterologist endoscopists: a multivariable analysis. Clin Gastroenterol Hepatol 2014(12):85–92

    Article  Google Scholar 

  3. Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E, Dabrowski A (2015) Endoscopic management of gastrointestinal perforations, leaks and fistulas. World J Gastroenterol WJG 21:10542–10552

    Article  CAS  PubMed  Google Scholar 

  4. Biancari F, D’Andrea V, Paone R, Marco C, Savino G, Koivukangas V et al (2013) Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 37:1051–1059. doi:10.1007/s00268-013-1951-7

    Article  PubMed  Google Scholar 

  5. Andriulli A, Loperfido S, Napolitano G (2007) Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 102:1781–1788

    Article  PubMed  Google Scholar 

  6. Iqbal CW, Cullinane DC, Schiller HJ (2008) Surgical management and outcomes of 165 colonoscopic perforations from a single institution. Arch Surg 143:701–706

    Article  PubMed  Google Scholar 

  7. Thill V, Simoens C, Mendes da Costa P (2010) Management of latrogenic perforation after gastrointestinal endoscopy. Hepato-gastroenterology 57:1465–1468

    CAS  PubMed  Google Scholar 

  8. Pilgrim CH, Nottle PD (2007) Laparoscopic repair of iatrogenic colonic perforation. Surg Laparosc Endosc Percutaneous Tech 17:215–217

    Article  Google Scholar 

  9. Changela K, Virk MA, Patel N, Duddempudi S, Krishnaiah M, Anand S (2014) Role of over the scope clips in the management of iatrogenic gastrointestinal perforations. World J Gastroenterol WJG 20:11460–11462

    Article  PubMed  Google Scholar 

  10. Yılmaz B, Unlu O, Roach EC, Can G, Efe C, Korkmaz U et al (2015) Endoscopic clips for the closure of acute iatrogenic perforations: where do we stand? Dig Endosc 27:641–648

    Article  PubMed  Google Scholar 

  11. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  12. Markar SR, Mackenzie H, Wiggins T, Askari A, Faiz O, Zaninotto G, Hanna GB (2015) Management and outcomes of esophageal perforation: a national study of 2,564 patients in England. Am J Gastroenterol 110(11):1559–1566. doi:10.1038/ajg.2015.304

    Article  PubMed  Google Scholar 

  13. Maeda K, Michida T, Kita H, Nishio A, Iwahashi K, Oonishi Y et al (2009) Perforation and its trouble shooting in endoscopic submucosal dissection (esd) for early gastric cancer (egc). Gastrointest Endosc 69:AB226

    Article  Google Scholar 

  14. Eroglu A, Turkyilmaz A, Aydin Y, Yekeler E, Karaoglanoglu N (2009) Current management of esophageal perforation: 20 years experience. Dis Esophagus 22:374–380

    Article  CAS  PubMed  Google Scholar 

  15. Avgerinos DV, Llaguna OH, Lo AY (2009) Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations. Surg Endosc 23:833–838

    Article  PubMed  Google Scholar 

  16. Wyse JM, Paquin SC, Sahai A (2009) Reducing the risk of pancreatico-biliary eus-related duodenal perforation: complete pancreatic eus without intubation of d2: a feasibility study. Gastrointest Endosc 69:249–250

    Google Scholar 

  17. Jeong S, Kim JH, Hwang JC, Yoo BM, Moon JH, Park S-H et al (2009) Clinical course and proposal for treatment strategy in the ercp-related duodenal perforation: a multicenter study. Gastrointest Endosc 69:144

    Google Scholar 

  18. Cho S, Lee W, Joo Y, Kim H, Park S, Park C et al (2012) Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc 26:473–479

    Article  PubMed  Google Scholar 

  19. Merali N, Hussain A (2015) Laparoscopic endoloop technique—a novel approach of managing iatrogenic caecal perforation and literature review. Int J Surg Case Rep 9:31–33

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Cai SL, Chen T, Yao LQ, Zhong YS (2015) Management of iatrogenic colorectal perforation: from surgery to endoscopy. World J Gastrointest Endosc 7:819–823

    Article  PubMed  PubMed Central  Google Scholar 

  21. van Halsema EE, van Hooft JE, Small AJ, Baron TH, García-Cano J, Cheon JH et al (2014) Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc 79:970–982

    Article  PubMed  Google Scholar 

  22. Shi X, Shan Y, Yu E, Fu C, Meng R, Zhang W et al (2014) Lower rate of colonoscopic perforation: 110,785 patients of colonoscopy performed by colorectal surgeons in a large teaching hospital in china. Surg Endosc 28:2309–2316

    Article  PubMed  Google Scholar 

  23. Paspatis GA, Vardas E, Theodoropoulou A, Manolaraki MM, Charoniti I, Papanikolaou N et al (2008) Complications of colonoscopy in a large public county hospital in Greece. a 10-year study. Dig Liver Dis 40:951–957

    Article  CAS  PubMed  Google Scholar 

  24. Misra T, Lalor E, Fedorak R (2004) Endoscopic perforation rates at a canadian university teaching hospital. Can J Gastroenterol Hepatol 18:221–226

    Google Scholar 

  25. Biancari F, Saarnio J, Mennander A, Hypen L, Salminen P, Kuttila K et al (2014) Outcome of patients with esophageal perforations: a multicenter study. World J Surg 38:902–909. doi:10.1007/s00268-013-2312-2

    Article  PubMed  Google Scholar 

  26. Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M (2011) Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 74(4):885–896

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chukmaitov A, Siangphoe U, Dahman B, Bradley CJ, BouHaidar D (2016) Patient comorbidity and serious adverse events after outpatient colonoscopy: population-based study from three states, 2006–2009. Dis Colon Rectum 59(7):677–687

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and 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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph A. Mallmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marlis A. Musch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin E. Kreis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jörn Gröne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Holmer.

Ethics declarations

Conflict of interest

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation