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Laparoscopic management of iatrogenic colon perforation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Iatrogenic colon perforation (ICP) due to colonoscopy is a severe complication and is associated with significant morbidity and mortality. The global estimated incidence of ICP is 0.03% and up to 3% for diagnostic and therapeutic colonoscopies, respectively. Treatment options include endoscopic repair, conservative therapy, and surgery. Treatment decision is based on the time and the setting of the diagnosis, the type, and location of the perforation, the presence of related pathologies, the clinical status and characteristic of the patient, and surgeon’s skills. We present our experience in the treatment of ICPs.

Methods

A retrospective review was undertaken of all patients suffering from ICP at Bnai-Zion Medical Center between 1/1/2010 and 1/3/2021. Clinical presentation, therapeutic approach, and short-term outcomes were analyzed.

Results

There were 51 cases of ICPs. Fourteen (27%) were diagnosed by the gastroenterologist during the procedure, 2 of whom were treated with endoscopic clips. The rest of the patients (72.5%) were diagnosed in the ER after a CT scan. Forty-three patients (84%) went on to operative management: 5 (11%) operations started with laparotomy—all were conducted in the early study period (until 2013). All other operations (88%) started with a diagnostic laparoscopy, 4 of whom (10%) were converted to laparotomy. Out of the 38 laparoscopic cases 29 (80%) were treated with primary suturing. Seven patients went on to colon resection (5 of whom with primary anastomosis). Six patients required ICU admission—with 1/38 (2%) from the laparoscopic cases, and 5/9 (55%) from the laparotomy cases. A total of 49/51 (96%) patients recovered and were discharged after 5 ± 2 for conservative and laparoscopic cases, and 12 ± 9 for open cases.

Conclusion

Laparoscopic treatment of ICP is safe and feasible in most cases. Our data supports a laparoscopic attempt at any such scenario.

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Data availability

The experimental data and the simulation results that support the findings of this study are available in Figshare with the identifier https://doi.org/10.6084/m9.figshare.23984067.

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Authors and Affiliations

  1. Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel

    Boaz Loberman, Eviatar Kuhnreich, Ibrahim Matter & Gideon Sroka

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  1. Boaz Loberman
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  2. Eviatar Kuhnreich
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  3. Ibrahim Matter
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  4. Gideon Sroka
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Boaz Loberman and Gideon Sroka. The first draft of the manuscript was written by Boaz Loberman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Boaz Loberman.

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The authors declare no competing interests.

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Loberman, B., Kuhnreich, E., Matter, I. et al. Laparoscopic management of iatrogenic colon perforation. Int J Colorectal Dis 38, 259 (2023). https://doi.org/10.1007/s00384-023-04550-2

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