Gedebou T M, Wong R A, Rappaport W D, Jaffe P, Kahsai D, Hunter G C
Department of General Surgery, University of Arizona Health Sciences Center, Tucson 85724, USA.
Am J Surg. 1996 Nov;172(5):454-7; discussion 457-8. doi: 10.1016/S0002-9610(96)00236-X.
Because iatrogenic colonic perforation is uncommon, surgical management of this complication has been based on the civilian trauma experience. In this study, we determine the incidence, clinical presentation, and management of colonic perforations resulting from colonoscopy or barium enema.
The medical records of all patients with colorectal perforations due to barium enema or colonoscopy seen over a 5-year period were reviewed.
Twenty-one patients, 12 males and 9 females aged 66 +/- 16 years, undergoing evaluation for polyps and bleeding (11), diverticulosis (4), diarrhea (2), or miscellaneous indications (4) sustained colonic perforation from colonoscopy (18; 0.20%) or barium enema (3; 0.10%). Abdominal pain, 66% (13), and fever, 24% (5), were the most frequent symptoms encountered and extraluminal air, 67% (14), the most common radiologic finding. The site of perforation was the rectosigmoid in 62% (13) of patients. Eighteen patients underwent surgery; 11 within 24 hours (group I) and 7 patients within 6.0 +/- 4 days (group II). Fifty percent (9 of 18) had primary repair or resection with anastomosis without mortality. Of the 6 patients initially treated nonoperatively, 3 subsequently underwent surgery. Both deaths, one in group I and one in group II, occurred in patients who had colonic diversion for perforation following colonoscopy.
We conclude that in the absence of significant contamination either primary repair or resection and anastomosis can be performed with acceptable morbidity for iatrogenic perforations of the colon.
由于医源性结肠穿孔并不常见，对该并发症的外科处理一直基于普通创伤的经验。在本研究中，我们确定了结肠镜检查或钡剂灌肠所致结肠穿孔的发生率、临床表现及处理方法。
回顾了5年间因钡剂灌肠或结肠镜检查导致大肠穿孔的所有患者的病历。
21例患者，12例男性，9例女性，年龄66±16岁，因息肉和出血（11例）、憩室病（4例）、腹泻（2例）或其他指征（4例）接受评估，其中18例（0.20%）因结肠镜检查、3例（0.10%）因钡剂灌肠发生结肠穿孔。腹痛（66%，13例）和发热（24%，5例）是最常见的症状，腔外积气（67%，14例）是最常见的影像学表现。62%（13例）患者的穿孔部位在直肠乙状结肠。18例患者接受了手术，11例在24小时内（I组），7例在6.0±4天内（II组）。50%（18例中的9例）进行了一期修复或切除吻合，无死亡病例。6例最初接受非手术治疗的患者中，3例随后接受了手术。2例死亡病例，1例在I组，1例在II组，均发生在结肠镜检查后因穿孔而行结肠转流术的患者中。
我们得出结论，在没有严重污染的情况下，对于医源性结肠穿孔，一期修复或切除吻合均可进行，其发病率可接受。
