Management of Colonoscopy Complications

Abstract

Complications after colonoscopy range from asymptomatic and self-limiting to serious life-threatening conditions. The most worrying complication is iatrogenic colonic perforation (ICP) due to barotrauma and mechanical trauma when the endoscope is pushed forward or to thermal/electrical injury of the colonic wall, with onset of symptoms after 24–72 h. CT scan is effective to detect even small amounts of fluid or air in the peritoneal or retroperitoneal space. Nonoperative management is appropriate for small sealed-off perforations, and endoscopic repair is possible intra-procedurally with small, large clips or sutures. Emergency surgery is indicated in signs of diffuse peritonitis, systemic inflammation, or sepsis. Laparoscopy is the first-line approach, and simple suture, wedge resection, segmental resection with anastomosis or stoma, and exteriorization of the perforation may be all performed laparoscopically. In unstable patients, open surgery is preferred. Bleeding is a complication after operative colonoscopies, which occurs with higher risk in resection of polyps larger than 2 cm or multiple, polyps in the right colon, and sessile polyps with villous histotype, anticoagulant or dual antiplatelet therapy. Treatment of bleeding is primarily endoscopic and rarely endovascular or surgical. Less frequent complications are cardiopulmonary events principally due to sedation and hernia strangulation due to increased abdominal pressure, splenic injury, and gas explosion.