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The Outcomes of Management for Colonoscopic Perforation: A 12-Year Experience at a Single Institute

대한대장항문학회지 2016년 32권 5호 p.175 ~ 183
 ( Park Jung-Yun ) - Inje University College of Medicine Inje University Ilsan Paik Hospital Department of Surgery

 ( Choi Pyong-Wha ) - Inje University College of Medicine Inje University Ilsan Paik Hospital Department of Surgery
 ( Jung Sung-Min ) - Inje University College of Medicine Inje University Ilsan Paik Hospital Department of Surgery
 ( Kim Nam-Hoon ) - Inje University College of Medicine Inje University Ilsan Paik Hospital Department of Surgery

Abstract


Purpose : Optimal management of colonoscopic perforation (CP) is controversial because early diagnosis and prompt management play critical roles in morbidity and mortality. Herein, we evaluate the outcomes and clinical characteristics of patients with CP according to treatment modality to help establish guidelines for managing CP.

Methods : Our retrospective analysis included 40 CP patients from January 1, 2003, to December 31, 2014. Patients with CP were categorized into 2 groups according to therapeutic modality: operation (surgery) and nonoperation (endo-luminal clip application or conservative treatment) groups.

Results : The postoperative morbidity rate was 40%, and no mortalities were noted. The incidence of abdominal pain and tenderness in patients who received only conservative management was significantly lower than in those who underwent surgery (P < 0.001 and P = 0.004, respectively). Patients tended to undergo surgery more often for diagnosis times longer than 24 hours and for diagnostic CPs. The mean hospital stays for the operation and nonoperation groups were 14.6 ± 7.77 and 5.9 ± 1.62 days, respectively (P < 0.001). Compared to the operation group, the nonoperation group began intake of liquid diets significantly earlier after perforation (3.8 ± 1.32 days vs. 5.6 ± 1.25 days, P < 0.001) and used antibiotics for a shorter duration (4.7 ± 1.29 days vs. 8.7 ± 2.23 days, P < 0.001).

Conclusion : The time of diagnosis and the injury mechanism may be useful indications for conservative management. Nonoperative management, such as endo-luminal clip application, might be beneficial, when feasible, for the treatment of patients with CP.

키워드

Colonoscopy; Perforation; Management
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