Risk Factors of Fecal Diversion for Colonoscopic Perforation: A Review of 35,361 Endoscopic Procedures

Kampol Toemakharathaworn, Voraboot Taweeruchana, Jirawat Swangsri, Thawatchai Akaraviputh, Asada Methasate, Vitoon Chinswangwatanakul, Thanyadej Nimmanwudipong, Atthaphorn Trakarnsanga. Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand..

 Introduction: Colonic perforation is considered as one of severe complications for endoscopic procedure of colon, including colonoscopy and sigmoidoscopy. This complication is unusual but has a high rate of mortality and morbidity. Fecal diversion (colostomy) may needs as a part of treatment in selected patients. The purpose of this study was to determine the risk factors influencing colostomy rate in the setting of iatrogenic colonoscopy perforation.
Methods: A retrospective analysis was conducted of all patients who underwent surgical treatment for colonoscopic perforation between January 2005 and August 2013. Patients underwent single-stage operation, including primary repair and segmental resection with anastomosis, were compared with the fecal diversion group. The potential risk factors of fecal diversion in term of age, perforated size, location of perforation, contamination, colonic pathology, and timing of diagnosis were reviewed and analyzed.
Results: There were 31 colonic perforations from 35,361 endoscopic procedures of colon, 32,426 colonoscopies and 2,935 flexible sigmoidscopies (incidence 0.09%). Thirty patients underwent surgical treatment divided into single stage operation in 21 patients (70%) and fecal diversion in 9 patients (30%). Age, timing of detection, perforated size and location of perforation were not significantly influenced the rate of fecal diversion. All 4 patients who had pathology at rectosigmoid colon (3 inflamatory bowel diseases and 1 radiation proctitis) underwent fecal diversion compared with 5 patients (19.2%) in normal rectosigmoid group (p= 0.005). Patients, who had moderate to severe intraabdominal contamination, were more likely to have colostomy (80% vs. 5%, p< 0.001).
Conclusions: Intraabdominal contamination and underlying colonic pathology were risk factors of fecal diversion for colonoscopic perforation in this recent study.

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