Colonoscopy of patients requiring laparotomy for repair. Colonoscopic

Colonoscopy is accepted as the gold standard approach for the assessment of
colorectal diseases. It has been associated with various complications,
and there is no doubt that perforation is the most
important of all (1). The incidence of iatrogenic colonic perforations
ranges between 0.005% and 0.63% with the larger part
of patients requiring laparotomy for repair. Colonoscopic perforation mechanisms
include blunt trauma to the colonic wall, barotrauma from air insufflation, inadvertent endoscopic resection or intemperate warm harm (1). The investigation made by An et al. uncovered
that in the management of colonic perforation, perforation size >15 mm is a critical indicator for conversion from non-surgical to
surgical procedures (2). So professional skill and education level of the
endoscopist come into prominence.

We report a 52-year-old lady who experienced
sigmoid perforation during diagnostic
colonoscopy. The diagnosis of perforation was made based on
clinical presentation, physical examination and radiological evidence, such as
detection of free air on direct radiography
(Fig.1). The patient was taken up for abdominal
exploration. There was no fecal matter in the peritoneal cavity.
Local peritonitis was mild. The perforation site was inspected and a 4-5 cm
sigmoid colon perforation was recognized (Fig.2). Resection with primary anastomosis performed. The postoperative course was uneventful and the patient was discharged
from the hospital 1 week after admission.

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To have
standard performance, endoscopist must have done at least 25-30 flexible
sigmoidoscopy and 200 colonoscopy (3). Qualification bencmarks for gastrointestinal endoscopic interventions are assessed on
the premise of the number of procedures performed. Discussion is often
about ‘Which type of doctor should do colonoscopy’. In my opinion this is a meaningless question as long as the
education given is well and quality standarts are met. A colonoscopy performed
by gastroenterologist, internist or surgeon reduces the risk for
colorectal cancer death— in any
case, when it’s performed by all around prepared endoscopist, the hazard for colon perfortion is least
of all. Cecal
intubation rate >90 %, adequate bowel preparation, post polypectomy bleeding
rate of < 0.5 %, and perforation rate of <0.1 % are all quality indicators for colonoscopy. Polypectomy and adenoma detection rates are additionally essential quality indicators; however there is no agreement on what the appropriate targets ought to be. There is insufficient evidence to suggest a minimum withdrawal time from the cecum (4, 5).


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