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Best Practices in Prevention, Detection, and Treatment of Colorectal Perforations During Axial Lumbar Interbody Fusion. Tech Orthop 2012. [DOI: 10.1097/bto.0b013e318263f3db] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech 2009; 18:561-4. [PMID: 19098660 DOI: 10.1097/sle.0b013e318182b025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Perforations of the colonic wall or splenic injury during colonoscopy are rare complications. Treatment of these complications by laparoscopy is an advisable compromise instead of an invasive surgery with a laparotomy or a noninvasive and potentially risky nonoperative therapy. All surgical procedures that can be performed by open approach can also be performed laparoscopically. We present in this report 15 patients who were treated for a perforation after colonoscopy. In addition, 2 cases of splenic injury after colonoscopy are described. Twelve perforations were sutured laparoscopically and 3 perforations were sutured via laparotomy. Except for 1 minor wound infection, there were no complications. One splenic injury was treated by spleen wrapping via an open approach due to former pancreatic surgery, and 1 injury was treated laparoscopically with a hemostypticum. Mortality was 0%. Early laparoscopic intervention is a safe and effective method in the treatment of serious complications after colonoscopy.
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Richterich JP, Heigl A, Muff B, Luchsinger S, Gutzwiller JP. Endo-SPONGE--a new endoscopic treatment option in colonoscopy. Gastrointest Endosc 2008; 68:1019-22. [PMID: 18534581 DOI: 10.1016/j.gie.2008.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Accepted: 02/18/2008] [Indexed: 02/08/2023]
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Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2007; 22:1500-4. [DOI: 10.1007/s00464-007-9682-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 08/30/2007] [Accepted: 10/03/2007] [Indexed: 12/16/2022]
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Rumstadt B, Schilling D. [Iatrogenic colon perforation: experiences with early laparoscopy]. Chirurg 2007; 79:346-50. [PMID: 17960349 DOI: 10.1007/s00104-007-1408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Perforation during colonoscopy is a rare but severe complication. PATIENTS AND METHODS Retrospective analysis was done of 15 patients operated on for perforation from colonoscopy between January 2000 and December 2006. RESULTS Three perforations occurred during diagnostics and 12 during interventional colonoscopy. Two perforations occurred as transmural thermal injury to the colon wall. Peritonitis was found in four cases and correlated significantly with mean time between perforation and operation. Twelve perforations were sutured laparoscopically and three by laparotomy. Hospital stay was significantly shorter after laparoscopic treatment than by laparotomy. One patient had a postoperative wound infection, and mortality was 0%. CONCLUSION Early laparoscopic suturing is a safe and effective method in the treatment of perforation from colonoscopy.
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Affiliation(s)
- B Rumstadt
- Chirurgische Klinik, Diakoniekrankenhaus Mannheim, Mannheim, Germany.
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Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 2007; 22:1409-14. [PMID: 17593224 DOI: 10.1111/j.1440-1746.2007.05022.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Colonic perforation is the serious accidental complication. The aim of this study is to analyze the clinical presentation and management of recent iatrogenic perforations during therapeutic colonoscopy. METHODS Consecutive patients referred to four academic cancer centers in Japan were retrospectively reviewed using each center's endoscopy database of medical records. Data was obtained by means of an extensive data collection sheet. Since we evaluated the data including iatrogenic perforation during newly developed therapeutic procedure such as endoscopic submucosal dissection (ESD) or hemoclips, the collection of patient data was set from the period of the beginning of ESD technique in each hospital in this study. RESULTS The overall rate of occurrence of perforation was 0.15% (23/15, 160). Perforation rate for EMR (0.58%) showed a significantly higher rate (P < 0.0001) than that for hot biopsy and polypectomy. The rate for ESD (14%) showed a markedly higher rate (P < 0.0001) than that for other standard procedures. Of those perforations, endoscopic clipping was performed in 56.5% of the patients, and conservative treatment was successful in 100% of the patients with successful closure. Both CT scan findings and serology results (WBC, CRP) after perforation were poor predictors for need for surgery as opposed to conservative management. CONCLUSIONS Further improvements in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms, because perforation rate for ESD shows a markedly higher. Conservative management may be possible in patients who have undergone complete endoscopic clipping.
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Affiliation(s)
- Keisei Taku
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
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Park HC, Kim DW, Kim SG, Park KJ, Park JG. Surgical Management of Colonoscopic Perforations. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2007. [DOI: 10.3393/jksc.2007.23.5.287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Hyoung-Chul Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Gahb Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Traditionally the placement of a peritoneal dialysis (PD) catheter in a patient with end-stage renal disease (ESRD) has been accomplished by a surgeon and using general anesthesia. This approach often introduces delays in starting PD, incurs additional costs in utilizing an operating room as well as anesthesia services, and introduces the mortality risk associated with general anesthesia. Recent data have emphasized that interventional nephrologists can safely and successfully perform PD access procedures. In this context, operating room facilities and staff and anesthesia services are not required and catheter insertion can be performed in a procedure room using local anesthesia, thereby reducing costs and completely bypassing the mortality risk associated with general anesthesia. When performed by a nephrologist, the catheter insertion can be accomplished swiftly and dialysis therapy initiated in a timely manner. Once begun, the success of PD hinges on reliable and long-term access to the peritoneal cavity. Prospective randomized and nonrandomized studies have shown that PD catheters peritoneoscopically placed by nephrologists have fewer complications (infection, exit site leak) and longer catheter survival rates than those inserted surgically. Although PD offers a variety of advantages, it remains an underutilized form of renal replacement therapy. To counteract PD underutilization, at least two separate centers have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists. This article presents PD access-related procedures currently performed by interventional nephrologists. Furthermore, some of the complicating issues (bowel perforation, catheter migration, prior abdominal surgery) related to PD catheter insertion and management are also discussed.
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Affiliation(s)
- Arif Asif
- Division of Nephrology, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA.
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Cobb WS, Heniford BT, Sigmon LB, Hasan R, Simms C, Kercher KW, Matthews BD. Colonoscopic Perforations: Incidence, Management, and Outcomes. Am Surg 2004. [DOI: 10.1177/000313480407000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fiberoptic colonoscopy provides superior diagnostic and therapeutic capabilities in the treatment of lower gastrointestinal disease processes. A well-recognized, but uncommon, complication during the procedure is perforation. The purpose of this study was to determine the incidence of colonoscopic perforation, define risk factors, assess the management of these complications, and evaluate outcomes. From January 1997 through December 2003, 43,609 colonoscopies were performed in our medical center. There were 14 (0.032%) perforations (1 in 3115 procedures); 7 from diagnostic and 7 from therapeutic procedures. General surgeons performed 1243 procedures (2.9%), and their rate of perforation was 0.080 per cent compared with 0.031 per cent for gastroenterologists during the same period. Half of the perforations occurred in the rectosigmoid, and the most common mechanism was mechanical (n = 6). Perforation was identified immediately during endoscopy in 50 per cent of the patients. Thirteen of 14 perforations were treated within 24 hours; 1 was delayed 48 hours. Initial surgical management was undertaken in 11/14 patients. Initial nonoperative treatment was attempted in three and was successful in only one patient. The mean length of stay following perforation was 11.2 days (range, 4–36 days). Three patients (21.4%) had 7 postoperative complications. Colonoscopic perforations are uncommon but can be recognized early and managed surgically with acceptable morbidity and postoperative length of stay.
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Affiliation(s)
- William S. Cobb
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Lee B. Sigmon
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Reem Hasan
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Connie Simms
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kent W. Kercher
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Brent D. Matthews
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Asif A, Byers P, Vieira CF, Merrill D, Gadalean F, Bourgoignie JJ, Leclercq B, Roth D, Gadallah MF. Peritoneoscopic placement of peritoneal dialysis catheter and bowel perforation: experience of an interventional nephrology program. Am J Kidney Dis 2004; 42:1270-4. [PMID: 14655200 DOI: 10.1053/j.ajkd.2003.08.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters. METHODS The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique. RESULTS Six (0.8%) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83%) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention. CONCLUSION Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.
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Affiliation(s)
- Arif Asif
- Department of Nephrology, Cleveland Clinic, Naples, FL 34119, USA
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Abstract
Iatrogenic perforation of the gastrointestinal tract is a medical emergency and is inevitable. An endoscopist must maintain a high index of suspicion despite minimal or atypical symptoms and negative radiologic studies, because perforation is a complication with tremendous morbidity and mortality. The endoscopist must know how to manage this complication appropriately and to seek immediate surgical consultation. There is ongoing controversy about when a patient should undergo nonoperative or surgical therapy. An evidence-based approach to manage iatrogenic perforation is not possible. The trend in the modern era is to less invasive, nonoperative therapy, given advancements in ICU care and antibiotics. Laparoscopy or laparoscopic-assisted (minilaparotomy) surgery is also being increasingly used with outcomes comparable with conventional laparotomy. Experience and advancements in accessories have enabled endoscopic repair of iatrogenic perforation in many situations [84]. The management algorithms provided synthesize the pertinent literature into reasonable guidelines to follow. Ultimately, an individualized approach must be taken to manage the patient with an iatrogenic perforation.
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Affiliation(s)
- Rajesh V Putcha
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Room F.4.310, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA
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Whittemore JC, Zucca L. Medical management of urethral and colonic perforation associated with urinary catheterization in a kitten. J Am Vet Med Assoc 2003; 223:815-6, 810. [PMID: 14507097 DOI: 10.2460/javma.2003.223.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 6-week-old male kitten was evaluated because of stranguria and possible urethral blockage; a urinary catheter placed during general anesthesia penetrated the urethral and colonic walls and entered the colon. Treatment was conservative, with fluids administered i.v., administration of piperacillin, and supportive care. The kitten never became febrile or clinically ill and continued to thrive. There was no development of clinical signs consistent with stricture, diverticulum, or fistula formation. Complications from urethral perforation include infection and urethral stricture. Reconstructive surgery is considered the treatment of choice for traumatic urethral-colonic perforation. However, surgery may not be feasible or may be cost-prohibitive in certain situations. In such instances, medical management may provide a reasonable alternative to euthanasia.
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