| Theme | Complications and their Managements for Gastrointestinal Endoscopy | |
|---|---|---|
| Title | Colonoscopic Perforations Following Polypectomy and Endoscopic Mucosal Resection -- Etiology, Diagnosis, and Management | |
| Publish Date | 2002/07 | |
| Author | Kazuo Hase | Department of Surgery, Self-Defense Forces Central Hospital |
| Author | Hiroshi Uchida | Department of Surgery, Self-Defense Forces Central Hospital |
| Author | Hiroyuki Wakiyama | Department of Surgery, Self-Defense Forces Central Hospital |
| Author | Takashi Hayashi | Department of Surgery, Self-Defense Forces Central Hospital |
| Author | Hitoshi Horii | Department of Surgery, Self-Defense Forces Central Hospital |
| Author | Kazushige Okada | Department of Surgery, Self-Defense Forces Central Hospital |
| [ Summary ] | The increasing number of colonoscopies with therapeutic interventions has raised the incidence of iatrogenic colonic perforations. Although these colonoscopic perforations rarely occur, the mortality rate from this complication may be significant. The management of patients with this type of colonoscopic perforation has been controversial. In general, patients with specially defined, limited perforations can be treated nonoperatively. Nonoperative management has been advocated for patients who are clinically stable, with good bowel preparation, mild or localized symptoms, and an absence of signs of diffuse or spreading peritoneal irritation. Nonsurgical management consists of antibiotics being given intravenously, nothing being given by mouth, nasogastric tubal decompression, and frequent clinical examinations. On the other hand, a suspected large perforation, diffuse or advancing peritonitis, or failure to improve with conservative management mandates prompt surgical exploration. | |