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Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals

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An Erratum to this article was published on 29 June 2013

Abstract

Background

The primary goal of this hospital-based retrospective multicenter case series study was to determine the incidence of large bowel full-thickness injury associated with colonoscopy in Lithuania. We assessed characteristics of patients who were treated as a result of this complication; management and outcomes were the secondary goals of this study.

Methods

The medical records of patients with iatrogenic large bowel perforations resulting from colonoscopy within the period January 1, 2007, to December 31, 2011, were retrospectively reviewed. Representatives of 14 Lithuanian public and private hospitals participated in the survey.

Results

A total of 56,882 colonoscopies were performed. Forty patients (23 female and 17 male patients) were reported to have iatrogenic full-thickness large bowel injury. Diagnostic and therapeutic colonoscopies resulted in perforation for 28 of 49,795 patients and 12 of 7,087 patients, respectively. A mean age of 70 years and a female preponderance for this complication was revealed. Sigmoid colon and rectosigmoid junction was perforated in 28 patients. All patients underwent surgical management, either primary repair (70.0 %) or bowel resection (30.0 %). Postoperative complications were diagnosed in 15 patients. Immediate treatment resulted in fewer intestinal resections and shorter hospital stays (p < 0.05). Smoking [odds ratio (OR) 14.4, 95 % confidence interval (CI) 1.16–179.8] and a large size perforation site (15 ± 10 vs. 8 ± 5 mm; OR 1.19, 95 % CI 1.03–1.38) were risk factors for developing a postoperative complication after curative surgery. Six patients died. All deaths were related to diagnostic colonoscopy.

Conclusions

Total incidence of large bowel full-thickness injury in Lithuanian hospitals is 0.07 %. Incidence of this complication after diagnostic and therapeutic colonoscopies is 0.056 and 0.169 %, respectively. The most common site of perforation is sigmoid colon and rectosigmoid junction, at 70 %. Risk rises when colonoscopy is performed in low-volume practice centers. Urgent surgical management resulted in overall mortality rate of 15.0 % and morbidity of 37.5 %.

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Acknowledgments

We would like to acknowledge the invaluable contribution of Varut Lohsiriwat, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand, for participation in designing this study. Special thanks to Arturas Razbadauskas, Klaipeda Jurininku Hospital, Klaipeda, Lithuania; Vincas Abaliksta, Siauliai Republican Hospital, Siauliai, Lithuania; and Gintautas Puteikis, Utena City Hospital, Utena, Lithuania, for kind collaboration in providing the addition data.

Disclosures

Drs. Samalavicius, Kazanavicius, Lunevicius, Poskus, Valantinas, Stanaitis, Grigaliunas, Gradauskas, Venskutonis, Samuolis, Sniuolis, Gajauskas, Kaselis, Leipus, and Radziunas have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Center of Oncosurgery, Institute of Oncology, Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, 1 Santariskiu str., LT-08660, Vilnius, Lithuania

    Narimantas Evaldas Samalavicius & Darius Kazanavicius

  2. University Hospitals Aintree, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK

    Raimundas Lunevicius

  3. 3rd Department of Surgery, Vilnius University Hospital Santariskiu Klinikos Center Branch, Zygimantu g. 3, 01102, Vilnius, Lithuania

    Tomas Poskus

  4. Clinic of Gastroenterology, Nephrourology and Surgery, Medical Faculty of Vilnius Univeristy, Vilnius University Hospital Santariskiu Klinikos, 2 Santariskiu str., 08661, Vilnius, Lithuania

    Jonas Valantinas & Juozas Stanaitis

  5. Department of Surgery, Vilnius University Republican Hospital, 29 Siltnamiu str., 04130, Vilnius, Lithuania

    Aurelijus Grigaliunas

  6. Clinic of Surgery, Vilnius University Hospital, 57 Antakalnio str., Vilnius, Lithuania

    Audrius Gradauskas

  7. Clinic of Surgery, Kaunas 2nd Hospital, 2 Josvainiu str., 47144, Kaunas, Lithuania

    Donatas Venskutonis

  8. Department of Surgery, Panevezys Republican Hospital, 25 Smelynes str., 35144, Panevezys, Lithuania

    Remigijus Samuolis

  9. Department of Surgery, Klaipeda University Hospital, 41 Liepojos str., 92288, Klaipeda, Lithuania

    Pranas Sniuolis

  10. Department of Endoscopy, Kaunas 3rd Hospital, 13 Hipodromo str., Kaunas, Lithuania

    Mindaugas Gajauskas

  11. Department of Surgery, Klaipeda District Hospital, 3 S. Neries str., 92231, Klaipeda, Lithuania

    Nerijus Kaselis

  12. Department of Surgery, Utena Hospital, 3 Aukstakalnio str., 28151, Utena, Lithuania

    Raimundas Leipus

  13. Medical Diagnostic Center, 32 V. Grybo str., 10318, Vilnius, Lithuania

    Gintautas Radziunas

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  1. Narimantas Evaldas Samalavicius
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  2. Darius Kazanavicius
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  15. Gintautas Radziunas
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Correspondence to Narimantas Evaldas Samalavicius.

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Samalavicius, N.E., Kazanavicius, D., Lunevicius, R. et al. Incidence, risk, management, and outcomes of iatrogenic full-thickness large bowel injury associated with 56,882 colonoscopies in 14 Lithuanian hospitals. Surg Endosc 27, 1628–1635 (2013). https://doi.org/10.1007/s00464-012-2642-4

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