Laparoscopic Management of Colonoscopic Perforations

Praneetha Narahari, MD. Saint Agnes Medical Providers, Fresno, CA

Colonoscopy is a surveillance tool for prevention and early detection of colon cancer. It is a low risk procedure, but nevertheless all procedures have an inherent complication rate. One of the major adverse event with an incidence of 0.2% is colonoscopic perforation. I report 4 cases of symptomatic colonoscopic perforations that were successfully managed with laparoscopy, without a complication

First patient had HIV and a lateral perforation of the descending colon. 2 layers of interrupted intracorporeal silk sutures were placed and peritonitis irrigated out. Sigmoidoscope confirmed integrity and adequacy of the repair. Second patient was a frail and elderly lady with a large lateral tear of an adhesed sigmoid colon. Adhesiolysis performed and again introcorporeal 2 layers of silk sutures applied.Third patient had ulcerative colitis and the diseased colon perforated in mid transverse colon. 2 layers of intracorporeal sutures were placed and omentum was sutured over the repair site. Fourth patient had a small perforation in the cecum and this was stapled with echelon stapler.

An adverse event can be traumatic in a patient undergoing surveillance. Laparoscopy offers smaller incisions, quicker recovery and maintenance of physiologic homeostasis. It is a good alternative to laparotomy which can be perceived as a major surgery.

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