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Perforations from colonoscopy during diagnosis and treatment of polyps.

Within a department specialized in surgical gastroenterology 11 perforations of the large bowel occurred over a 10 year period as complication of diagnosis and treatment of polyps by colonoscopy. The incidence by diagnostic colonoscopy was 0.6% (95% confidence interval 0.2-1.3%) and by polypectomy 0.7% (95% confidence interval 0.2-1.8%). Nine of the perforations were located in the sigmoid colon; one occurred retroperitonally in the descending colon. The lesions were from 1-8 cm long and were located in normal bowelsegments. The most important cause of perforation was forceful introduction of the scope and the use of electrocoagulation. The patients were treated by laparotomy and antibiotics. In six cases the operation was initiated within one hour after the perforation had occurred, the remaining 5 were operated on when they developed symptoms 1/2-3 days after the colonoscopy. One patient, a 84-year-old man, died of acute myocardial infarction 4 weeks after the operation.