Iatrogenic perforation of colon and rectum

University of Illinois at the Medical Center Department of Surgery, Abraham Lincoln School of Medicine Chicago Illinois Chicago Illinois
Diseases of the Colon & Rectum (Impact Factor: 3.75). 01/1982; 25(4):305-8. DOI: 10.1007/BF02553602
Source: PubMed


In eight years at Cook County Hospital, 42,000 barium enemas, 16,325 proctosigmoidoscopies, and 1207 colonoscopies were performed. All endoscopic procedures were done by the house staff. There were three perforations due to proctosigmoidoscopy, with one death; three perforations due to colonoscopy, with no deaths; and seven perforations due to barium enema, with no survivors. The adjuvant effect of barium sulfate is proposed as the most likely cause for this excessively high mortality in barium-enema perforation.

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    • "Pneumoperitoneum detected after colonoscopy may pose a management dilemma [1] [8]. There are those who believe that all patients with a colon perforation following colonoscopy should have immediate surgery [16] [17]. Early laparotomy is thought to be associated with less morbidity and mortality [18]. "
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    ABSTRACT: Pneumoperitoneum frequently indicates a perforated abdominal viscus that requires emergent surgical management. However; pneumoperitoneum, on rare occasion, can occur without perforation. In these cases, it is defined as benign pneumoperitoneum. Benign pneumoperitoneum means asymptomatic free intra-abdominal air or pneumoperitoneum without peritonitis and can occur occasionally with colonoscopy. In this paper, we present a rare case of benign pneumoperitoneum that developed after diagnostic colonoscopy and review it in conjunction with the current literature.
    Case Reports in Medicine 06/2010; 2010:631036. DOI:10.1155/2010/631036
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    • "Large series of rigid sigmoidoscopic examinations indicate that there is a negligible risk of colonic perforation (about 1.2-1.8 per 10,000 examinations) where experienced examiners perform sigmoidoscopy (Bolt, 1971; Nelson, Abcarian and Prasad, 1982). The risk of minor morbidity (bleeding) is assumed to be 0.16%. "

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    ABSTRACT: Initial reports on HemoQuant, a new quantitative test for occult gastrointestinal bleeding, suggest it is more sensitive than Hemoccult. Increased detection of upper gastrointestinal tract bleeding and dietary hemoglobin may reduce HemoQuant's specificity in the screening setting. The authors performed a cost effectiveness analysis comparing Hemoccult and HemoQuant for colorectal cancer screening using assumptions based on probabilities and costs in the current literature, varying the specificity of HemoQuant. The analysis showed the marginal cost effectiveness of Hemoccult versus no test to be $43,000, and HemoQuant versus Hemoccult to be $296,000 if HemoQuant specificity is 0.95. The marginal cost effectiveness ratio increased to $601,000 if three HemoQuant tests were used. Survival benefit was small and highly dependent on Hemoccult sensitivity and mortality from colonoscopy if HemoQuant specificity was less than 0.9. The authors conclude that unless the high sensitivity reported for HemoQuant is accompanied by a specificity comparable to that of Hemoccult, HemoQuant may not be an acceptable alternative for colorectal cancer screening.
    Journal of General Internal Medicine 03/1988; 3(2):132-8. DOI:10.1007/BF02596117 · 3.45 Impact Factor
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