Colonoscopy is accepted as the gold standard techniquefor the assessment of colon and distal ileum diseases. It has been associatedwith various complications, and there is no doubt that perforation is the mostimportant of all (1). The incidence of iatrogenic colonic perforations rangesbetween 0.005% and 0.
63% with the majority of patients requiring laparotomy forrepair. Colonoscopic perforation mechanisms are blunt trauma to the colonicwall, barotrauma from air insufflation, unintentional endoscopic resection orexcessive thermal injury (1).The study made by An et al. revealed that in themanagement of colonic perforation, perforation size >15 mm is a significantpredictor for conversion from non-surgical to surgical procedures (2).
Soprofessional skill and education level of the endoscopist come into prominence.We report a 52-year-oldwoman who experienced sigmoid perforation duringdiagnostic colonoscopy. The diagnosis of perforation was made based onclinical presentation, physical examination and radiologic evidence, such asdetection of free air on simple radiography (Fig.1). The patient was taken upfor emergency laparotomy.
No fecalmatter was identified in the peritoneal cavity. Local peritonitis was mild. Theperforation site was inspected and a 4-5 cm sigmoid colon perforation wasrecognized(Fig.2).
Resection with primaryanastomosis performed. The postoperativecourse was uneventful and the patient was discharged from the hospital 1 weekafter admission.Tohave standard performance, endoscopist must have done at least 25-30 flexiblesigmoidoscopy and 200 colonoscopy (3).
Qualification standardsfor gastrointestinal procedures are assessed on the basis of the number ofendoscopic procedures performed. Discussion is oftenabout ‘Which type of doctor should do colonoscopy’. In my opinion this is a meaningless question as long as theeducation given is well and quality standarts are met. A colonoscopy performedby gastroenterologist, internist or surgeon reduces the risk forcolorectal cancer death— but when it’s performed by well trained endoscopist,the risk for colon perforation is lowest 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 forcolonoscopy. Polypectomy and adenoma detection rates are also important qualityindicators; however there is no consensus on what the appropriate targetsshould be. There is insufficient evidence to suggest a minimum withdrawal timefrom the cecum (4,5).