当前位置： SCI文献检索 > MAYO CLINIC PROCEEDINGS期刊下所有文献 > Management of colonoscopic perforations.

Management of colonoscopic perforations.

Abstract：

OBJECTIVE:To document our evolving surgical management of colonoscopic perforation and examine factors crucial to the improvement of patient care. DESIGN:We conducted a computer-based retrospective analysis of medical records (1980 through 1995). MATERIAL AND METHODS:Among 57,028 colonoscopic procedures performed, 43 patients (0.075%, or 1 perforation in 1,333 procedures) had a colonic perforation. Two additional patients were treated after colonoscopy performed elsewhere. The outcomes analyzed included surgical morbidity and mortality. RESULTS:Twenty-six women and 19 men who ranged in age from 28 to 85 years (median, 69) were treated for colonic perforation. More than 80% of perforations occurred during the latter half of the study period because of the increased volume of colonoscopic procedures (8 perforations among 12,581 examinations from 1980 through 1987 versus 35 perforations among 44,447 colonoscopies from 1988 through 1995). Emergency laparotomy was performed in 42 patients (93%). Perforations occurred throughout the colon: right side = 10; transverse = 9; and left side = 23. Three patients without evidence of peritoneal irritation fared well with nonoperative management. Most patients underwent primary repair or limited resection in conjunction with end-to-end anastomosis. In 14 patients (33%), an ostomy was created. One patient underwent laparotomy without further treatment. Intra-abdominal contamination ranged from none (31%) to local soiling (48%) to diffusely feculent (21%). Postoperative complications occurred in 12 patients and were associated with older age (P = 0.01), large perforations (P = 0.03), and prior hospitalization (P = 0.04). No postoperative deaths occurred. CONCLUSION:Despite a consistently low risk of colonic perforation, the increasing use of colonoscopy in our practice has resulted in an increased number of iatrogenic colonic perforations. In order to minimize morbidity and mortality, prompt operative intervention is the best strategy in most patients. Non-operative management is warranted in carefully selected patients without peritoneal irritation.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Farley DR,Bannon MP,Zietlow SP,Pemberton JH,Ilstrup DM,Larson DR

doi

10.1016/S0025-6196(11)63592-1

subject

Has Abstract

pub_date

1997-08-01 00:00:00

pages

729-33

issue

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(11)63592-1

journal_volume

pub_type

杂志文章

在线工具

Management of colonoscopic perforations.