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Iatrogenic perforation at colonic imaging
Author(s) -
Khan J. S.,
Moran B. J.
Publication year - 2011
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.02147.x
Subject(s) - medicine , perforation , barium enema , colonoscopy , radiology , endoscopy , incidence (geometry) , complication , cochrane library , surgery , general surgery , colorectal cancer , randomized controlled trial , cancer , materials science , physics , punching , metallurgy , optics
Aim Adequate colonic imaging is generally an invasive procedure with attendant risks, particularly perforation. Endoscopy, barium enema and computed tomographic colonography (CTC) are the main techniques for investigating patients with symptoms of, or screening for, colorectal cancer. The potential complications of these investigations have to be weighed against the benefits. This article reviews the literature on the incidence, presentation and management of iatrogenic colonic perforation at colonic imaging. Method A literature review of relevant studies was undertaken using PubMed, Cochrane library and personal archives of references. Manual cross‐referencing was performed, and relevant references from selected articles were reviewed. Studies reporting complications of endoscopy, barium enema and CT colonography were included in this review. Results Twenty‐four studies were identified comprising 640 433 colonoscopies, with iatrogenic perforation recorded in 585 patients (0.06%). The reported perforation rate with double‐contrast barium enema was between 0.02 and 0.24%. Serious complications with CTC were infrequent, though nine perforations were reported in a case series of 24 365 patients (0.036%) undergoing CTC. Conclusion Perforation remains an infrequent and almost certainly under‐reported, complication of all colonic imaging modalities. Risk awareness, early diagnosis and active management of iatrogenic perforation minimizes an adverse outcome.