Management of Latrogenic Colonic Perforation During Screening Colonoscopy: Case Series
Keywords:
Colorectal cancer, Iatrogenic colonic perforation, Colonoscopy, Surgical management, Endoscopic clippingAbstract
Objective: To investigate the clinical characteristics, risk factors, and treatment outcomes of patients with iatrogenic colonic perforation during screening colonoscopy.
Methods: A descriptive study was conducted on nine patients diagnosed with colonic perforation during screening colonoscopy at Samutsakhon Hospital between July 1, 2020 and August 31, 2025. Demographic data, etiology, clinical presentation, perforation site and size, treatment methods, complications, reoperation, and 30-day mortality were analysed using frequency and percentage statistics.
Results: The mean age was 69 years, with 56% female patients and a mean BMI of 22.6 kg/m². Most patients (78%) had comorbidities. The most common site of perforation was the sigmoid colon (67%), with an average size of 1 cm. The leading cause was severe colonic angulation (44%), followed by endoscopic mucosal resection (22%). Diagnosis was made during colonoscopy in 89% of cases. Seven patients underwent surgery and two were treated with endoscopic clipping. In the surgical group, complications occurred in 43%, reoperation in 29%, and mortality in 14%. In the clipping group, one patient developed bleeding, but no reoperation or mortality was reported.
Conclusion: Severe colonic angulation and endoscopic mucosal resection were the main causes of colon perforation during colonoscopy, most frequently occurring in the sigmoid colon. Endoscopic clipping is a safe and effective treatment option, while surgery remains an important approach for patients who cannot be managed endoscopically or are clinically unstable.
References
Argilés G, Tabernero J, Labinca R, Hochhauser D, Salazar R, Iveson T, et al. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020; 31(10): 1291 – 1305.
Tiankanon K, Aniwan S, Rerknimitr R. Current Status of Colorectal Cancer and Its Public Health Burden in Thailand. Clin Endosc. 2021; 54(4): 499 - 504. doi: 10.5946/ce.2020.245-IDEN
Can OF, Bozdag A. Iatrogenic Colon Perforation Due to Colonoscopy Presenting as a Diffuse Subcutaneous Emphysema. Turk J Colorectal Dis. 2020; 30(3): 201 - 4. doi: 10.4274/tjcd.galenos.2020.2019-12-3.
Khan M, Ijaz M, Bukhari S, Dirweesh A, Christmad D. Post-Colonoscopy Colonic Perforation Presenting with Subcutaneous Emphysema: A Case Report. Gastroenterology Res. 2017; 20(2): 135 – 7.
Gülaydın N, Iliaz R, Özkan A, Gökçe AH, Önalan H, Önalan B et al. Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience. Turk J Surg. 2022; 38(3): 221 - 9. doi: 10.47717/turkjsurg.2022.5638.
De'Angelis N, Saverio SD, Chiara O, Sartelli M, Martínez-Pérez A, Patrizi F et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg. 2018; 13(1). doi: 10.1186/s13017-018-0162-9
Tawheed A, Bahcecioglu IH, Yalniz M, Ozercan M, Oral AC, El-Kassas M. Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy. World J Clin Cases 2025; 13(6): 97545. DOI: 10.12998/wjcc.v13.i6.97545
Iqbal CW, Cullinane DC, Schiller HJ, Sawyer MD, Zietlow SP, Farley DR. Surgical Management and Outcomes of 165 colonoscopic Perforations From a Single Institution. Arch Surg. 2008; 143(7): 701-7. doi:10.1001/archsurg.143.7.701
Siriwaleerat C. Colonoscopic Perforation Incidence and Risk Factors in Rajavithi Training Hospital. Thai J Surg. 2023; 44(1): 23 - 8.
Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol. 2010; 16(4): 425 - 30.
A Arora G, Mannalithara A, Singh G, Gerson LB, Triadafilopoulos G. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc. 2009; 69(3 Pt 2): 654 – 64.
Thompson EV, Snyder JR. Recognition and Management of Colonic Perforation following Endoscopy. Clin Colon Rectal Surg. 2019; 32(3): 183 - 9. doi: 10.1055/s-0038-1677024.
Cha RR, Kim HJ, Lee CM, Lee JM, Lee SS, Cho HJ et al. Clinical characteristics and outcome of iatrogenic colonic perforation related to diagnostic vs. therapeutic colonoscopy. Surg Endosc. 2022; 36(8): 5938 – 46. DOI: 10.1007/s00464-022-09010-6
Park JY, Choi PW, Jung SM, Kim NH. The outcomes of management for colonoscopic perforation: a 12-year experience at a single institute. Ann Coloproctol. 2016; 32(5): 175-83. doi:10.3393/ac.2016.32.5.175
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the x may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.use or modification of the articles is prohibited without permission.
statements expressed in the articles are solely the opinions of the authors.
authors are fully responsible for the content and accuracy of their articles.
other reuse or republication requires permission from the journal."
