García Eduardo, López-Köstner Francisco, Rollan Antonio, Muñoz Rodrigo, Contardo María José, Bellolio Felipe, García Ximena
Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Chile.
Rev Med Chil. 2008 Mar;136(3):310-6. Epub 2008 Jun 3.
Colon perforation is an uncommon but feared complication of colonoscopy. The treatment is usually surgical but occasionally it does not require an operation.
To report our experience in the diagnosis and management of colon perforation after colonoscopy.
Retrospective review of the database of 11,720 colonoscopies. The medical records of those patients that had a perforation were reviewed.
Twelve perforations in patients aged 26 to 92 years (six women), were identified with a global perforation rate of 0.1%. Five occurred during diagnostic and seven during therapeutic procedures. All perforations were confirmed by a plain X ray or CT scan of the abdomen. Four patients, without signs of initial diffuse peritoneal irritation, were medically treated. One of these, finally required surgery. Among operated patients, a primary suture was done in five, a primary excision without colostomy in three and a Hartmann procedure due to a severe peritoneal contamination in one. No patient died.
There is a higher risk of colon perforation during therapeutic colonoscopies. Selected cases may be safely treated without surgery.
结肠穿孔是结肠镜检查中一种罕见但令人担忧的并发症。治疗通常采用手术方式，但偶尔也无需手术。
报告我们在结肠镜检查后结肠穿孔的诊断和处理方面的经验。
回顾性分析11720例结肠镜检查的数据库。对发生穿孔的患者病历进行了审查。
共识别出12例结肠穿孔患者，年龄在26至92岁之间（6名女性），总体穿孔率为0.1%。5例发生在诊断性检查过程中，7例发生在治疗性操作过程中。所有穿孔均经腹部平片或CT扫描确诊。4例最初无弥漫性腹膜刺激征的患者接受了内科治疗。其中1例最终需要手术。在接受手术的患者中，5例行一期缝合，3例行一期切除且未行结肠造口术，1例因严重腹膜污染行哈特曼手术。无患者死亡。
治疗性结肠镜检查期间结肠穿孔的风险较高。部分病例可不通过手术而安全治疗。
