Also, some patients have other colon pathology noted during endoscopy that may necessitate surgical treatment of a perforation, even if they remain asymptomatic. Examples of this would include the presence of a large sessile polyp likely to be a carcinoma, unremitting colitis, or a perforation proximal to a nearly obstructing colonic lesion. If there is limited bowel injury not associated with pre-existing colonic pathology, and if there is minimal fecal soilage, a simple primary repair can be done. If the patient has more extensive colonic injury, and limited or moderate fecal soilage, resection of the damaged colon in conjunction with re-anastamosis can be done. If there is extensive peritoneal soilage, a colectomy with colostomy is preferred.
Perforation is an infrequent but important complication of colonoscopy.
The cecum is the most susceptible to iatrogenic perforation, but the sigmoid colon is the most common site. There is a wide spectrum of presentations, ranging from asymptomatic pneumoperitoneum to frank peritonitis. Most patients present within 24 hours of colonoscopy, but some presentations may be delayed for up to several days. Any patient that does not respond to or worsens with conservative therapy needs surgical treatment. Diseases of the Colon and Rectum.