Laparoscopic Treatment of Iatrogenic Endoscopic Colon Perforation with Diffuse Peritonitis – Case Report

Josip Bakovic, MD, Toni Kolak, MD PhD, Igor Stipancic, MD PhD, Milan Miocinovic, MD, Robert Klicek, MD, Mario Knezevic, MD. Department of Abdominal Surgery, Clinical Hospital Dubrava, Zagreb, Croatia

BACKGROUND: Iatrogenic perforation of the colon during elective colonoscopy is a rare but serious complication which can be fatal. Last years laparoscopic treatman of iatrogenic colon perforation presents the last frontier in treatment of this serious complication, particularly in patients with diffuse peritonitis.
CASE REPORT: A 61 year old female was admitted to our surgical emergency two day after colonoscopic polipectomy of sesile polyp in ascedens part of colon. She was presented with clinical signes of diffuse peritonitis and fever, axillary temperature was 38 C. Radiologic finding showed that there was a free air in abdominal cavity. Lab finding showed elevated white cell count 15.8, and C-reactiv protein 90.9. Other laboratory findings were normal. An urgent laparoscopic exploration was performed. Intraabdominal diffuse peritonitis was found with perforation on antimesenteric part of ascedent part of colon. Abdominal cavity was washout with a large quantity of saline. Perforation was sutured with interrupted suture, Vicrl 2-0 and omental patch was used. Postoperative course was without complication. The patient was discharged from hospital sixth day after surgery with normal laboratory and clinical findings.
CONCLUSIONS: Laparoscopic approach to iatrogenic colon perforation with diffuse peritonitis in selected cases can be used as a method of choice.