Selective management of colonoscopic perforations.
BACKGROUND: Colonoscopy is a safe procedure if performed properly. Perforations from such procedures are rare, but not entirely avoidable. Usually perforations from diagnostic colonoscopy result in large defects requiring surgical management. Perforations from therapeutic colonoscopy occur by a different mechanism and frequently result in a smaller perforation. STUDY DESIGN: This is a retrospective review of 26,708 consecutive colonoscopic procedures performed from January 1986 to June 1992. RESULTS: There were 12 perforations, five from diagnostic colonoscopy and seven from therapeutic colonoscopy. All patients with perforation from diagnostic colonoscopy were treated operatively, while six of the seven perforations from therapeutic colonoscopy were managed nonoperatively. The type of operation depended upon the intraoperative findings. CONCLUSIONS: Perforations from therapeutic colonoscopy occur by a different mechanism than from diagnostic colonoscopy and may be selectively managed without an operation and with a low mortality and morbidity rate, provided proper guidelines are adhered to.