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대장내시경에 의한 대장천공의 치료

Treatment of Colon Perforation Associated with Colonoscopy

대한대장항문학회지 2008년 24권 5호 p.322 ~ 328
박혜란 ( Park Hae-Ran ) - 계명대학교 의과대학 외과학교실

백성규 ( Baek Seong-Kyu ) - 계명대학교 의과대학 외과학교실
박성대 ( Park Sung-Dae ) - 계명대학교 의과대학 외과학교실
배옥석 ( Bae Ok-Suk ) - 계명대학교 의과대학 외과학교실

Abstract


Purpose: Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy.

Methods: The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed.

Results: In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas.

Conclusions: Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted. J Korean Soc Coloproctol 2008;24:322-328

키워드

대장 천공;대장내시경
Colon perforatio;Colonoscopy
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