Abstract
BACKGROUND
In recent years, colonoscopy, as the most important tool for the diagnosis and treatment of colorectal diseases, has been widely used in clinical practice, but it is somewhat invasive and may lead to a series of serious complications such as gastrointestinal bleeding and perforation. Among them, gastrointestinal perforation, if not detected and treated timely, can cause septic shock, and even endanger life.
AIM
To analyze the risk factors that may lead to colonoscopy-related perforation and explore the reasonable treatment for patients with perforation.
METHODS
A total of 41642 patients who underwent electronic colonoscopy at our hospital from January 2012 to December 2020 were statistically analyzed. The general information of the patients (gender, age, past history, body mass index, anesthesia, intestinal cleanliness, operating time, perforation site, etc.) was reviewed, and the risk factors for colonoscopy-related perforation were analyzed. The clinical efficacy and prognosis were compared between laparoscopic surgery (LS) and open surgery (OS).
RESULTS
Intestinal perforation occurred in 21 (0.05%) patients, including 13 cases of perforation caused by colonoscopy and 8 cases caused by treatment (including entrapment polypectomy, endoscopic mucosal resection, balloon dilation, and other invasive procedures). The most common perforation sites were the sigmoid colon (47.6%) and rectum (28.6%). Laparoscopic surgery was performed in 13 cases, open surgery in 7, conservative treatment in 1, and enterostomy in 3. Logistic regression analysis indicated that intestinal cleanliness, anesthesia, and abdominal operation history were the risk factors for colonoscopy-related perforation (P < 0.05), while gender, age, body mass index, examination, and treatment were not (P < 0.05).The postoperative length of stay, postoperative pain score, wound infection rate, and hospitalization cost in the LS group were significantly different from those in the OS group.
CONCLUSION
Colonoscopy-related perforation more commonly occurs in the sigmoid colon and rectum. Roughness of operation, weak local intestinal wall, and abnormal anatomical structure are three important factors leading to intestinal perforation. Poor intestinal cleanliness and previous history of abdominal surgery are high risk factors for perforation, while early detection and active surgery are the basic principles for the treatment of intestinal perforation, and laparoscopic perforation repair is the first choice. If bowel preparation is ready, it is safe and feasible to avoid a prophylactic enterostomy in most patients with colonoscopy perforation.
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