Laparoscopic management of iatrogenic colonic rupture

Abstract

ABSTRACT Latrogenic colonic perforation is a rare but serious complication of colonoscopies, with a range of underlying mechanisms, including mechanical and thermal causes, for which early detection and prompt action are essential. The management of this injury should be based on individual case factors, including the size of the perforation and the time of detection. Herein, we present the case of a 36-year-old woman who was referred to our surgical facility after a suspicion of colonic perforation during a colonoscopy. The diagnosis was confirmed through a computed tomography scan of the abdomen, which showed gross pneumoperitoneum and free fluid in the pelvis. Surgery revealed a very large colonic perforation, involving most of the wall circumference, which was subsequently classified as a colonic rupture caused by mechanical injury; the perforated segment was resected and a side-to-side hand-sewn anastomosis was created; surgery was completed laparoscopically. Early detection of the perforation in a well-prepared colon allowed for primary anastomosis without the need for fecal diversion or stoma. The patient had an uncomplicated postoperative course.