| Theme |
Management for the risk of colonoscopy |
| Title |
Etiology, diagnosis, and management for colonoscopic perforation |
| Author |
Mitsuhiro Fujishiro |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Naohisa Yahagi |
Department of Gastroenterology and Digestive Endoscopy Unit, Toranomon Hospital |
| Author |
Masanori Nakamura |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Naomi Kakushima |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Shinya Kodashima |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Katsuya Kobayashi |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Takuhei Hashimoto |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Nobutake Yamamichi |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Ayako Tateishi |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| Author |
Masao Omata |
Department of Gastroenterology, Graduate school of Medicine, University of Tokyo |
| [ Summary ] |
It is visible understand etiology and how to diagnose and manage colonoscopic perforations in order to prevent life-threatening complications. The incidence of colonoscopic complications was reported to have increased to 0.069 % between 1998 and 2002 in Japan and the majority were due to perforations. In these cases some patients died. The etiology was divided into three categories ; 1. barotraumas ; 2. mechanical mechanisms and ; 3. therapeutic colonoscopies. Perforation was noticed through clinical signs and symptoms, plain rhentogenograms, or computed tomography. Management depends on mechanisms and size of perforatin, adequacy of bowel preparation, underlying colonic diseases, general condition of the patient, time of diagnosis after perforation, etc. If the conditions are favorable, the perforation can be managed without surgical rescue. We know of no cases of perforation during diagnostic and therapeutic colonoscopies except for endoscopic submucosal dissection, at least in the past five years. Endoscopic submucosal dissection caused perforation in several cases, but all of these were managed without surgical rescue by closure of the perforation with endoclips, about three days' complete rest on bed and fasting, and about one week of intravenous antibiotics, as in the presented case. |