• Colonoscopy
• Incidence
• Perforation
• Risk factor

• 2020R1F1A1066115 National Research Foundation of Korea
• 2021R1A5A2021614 National Research Foundation of Korea

• Adverse event
• Colonoscopy
• Complication
• ESD
• Endoscopic resection
• Endoscopic submucosal dissection
• Gastrointestinal endoscopy
• Perforation

Ileoscopy is increasingly performed in dogs and cats with gastrointestinal signs, but iatrogenic ileocecocolic (ICC) perforations have not been described.

To characterize endoscopic ICC perforations in dogs and cats.

Thirteen dogs and 2 cats.

This is a retrospective case series. Signalment, presentation, endoscopic equipment, colonic preparation, endoscopist's experience level, ileal intubation technique, method of diagnosis, perforation location, histopathology, management, and outcome data were collected and reviewed.

Six ileal, 5 cecal, and 4 colonic perforations were identified between 2012 and 2019. Dogs weighed 2.4‐26 kg (median, 10.3 kg) and cats 4.6‐5.1 kg (median, 4.9 kg). Endoscopy was performed in dogs presented for vomiting (n = 4), as well as large (n = 5), mixed (n = 4), and small (n = 1) bowel diarrhea. Cats had large bowel diarrhea. Endoscopists included 1 supervised intern, 9 supervised internal medicine residents (2 first year, 6 second year, 1 third year), and 5 internal medicine diplomates. Diagnosis was delayed in 5 dogs, occurring 1‐5 days after endoscopy (median, 3 days); dogs were presented again with inappetence (n = 4), lethargy (n = 4), abdominal pain (n = 3), retching (n = 2), and syncope (n = 1). All animals underwent surgical correction. Histopathology did not identify lesions at the perforation site in any animal. Two dogs required a second surgery; 1 died 12 hours after surgery. Survival to discharge was 93%, with 78% surviving ≥8 months.

Iatrogenic endoscopic ICC perforation is not indicative of underlying disease and is associated with a good prognosis. Delayed diagnosis can occur. Therefore, perforation should be considered in the differential diagnosis for animals with clinical deterioration after endoscopy.

• cecum
• colon
• colonoscopy
• complication
• ileoscopy
• ileum
• pneumoperitoneum

• colonoscopy
• endoscopic procedures
• endoscopy

• Endoscopy
• Therapeutics

We describe the case of a 37-year-old gentleman with Crohn's disease and a complex surgical history including a giant incisional hernia with no abdominal wall. He presented on a Sunday to the general surgical on-call with a four-day history of generalised abdominal pain, nausea, and decreased stoma output following colonoscopy. After CT imaging, he was diagnosed with a large colonic perforation. Initially, he was worked up for theatre but following early senior input, a conservative approach with antibiotics was adopted. The patient improved significantly and is currently awaiting plastic surgery input for the management of his abdominal wall defect.

• Colonoscopy
• Endoscopic perforation
• Peritonitis
• Surgery

• Colon cancer
• ESD
• Endoscopic submucosal dissection
• Rectal cancer
• Relapse
• Training

• Bleeding
• Colonoscopy
• Complications
• Endoscopic mucosal resection
• Endoscopic submucosal dissection
• Perforation
• Polypectomy

• Colonic Neoplasms/surgery
• Colonic Polyps/pathology
• Colonic Polyps/surgery
• Colonoscopy/instrumentation
• Dissection/adverse effects
• Endoscopic Mucosal Resection/adverse effects
• Endoscopic Mucosal Resection/instrumentation
• Humans
• Intestinal Mucosa/surgery
• Intraoperative Complications/etiology
• Intraoperative Complications/prevention & control
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control

Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations.

We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea.

A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively.

Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

• Colonoscopic perforation
• Colonoscopy
• Laparoscopic surgery

Iatrogenic colon perforation is one the most pernicious complications for patients undergoing endoscopic screening or therapy. It is a serious but rare complication of colonoscopy. However, with the expansion of the indications for endoscopic therapies for gastrointestinal diseases, the frequency of colorectal perforation has increased. The management of iatrogenic colorectal perforation is still a challenge for many endoscopists. The methods for treating this complication vary, including conservative treatment, surgical treatment, laparoscopy and endoscopy. In this review, we highlight the etiology, recognition and treatment of colorectal iatrogenic perforation. Specifically, we shed light on the endoscopic management of this rare complication.

• Iatrogenic perforation
• Colorectum
• Surgery
• Laparoscopy
• Endoscopy

• colonoscopy complication
• endoscopic closure
• perforation
• postpolypectomy bleeding

Colonic perforation occurs in a variety of clinical scenarios and colonoscopy-associated perforation is one of the important reasons for colonic perforation. Colonoscopy-associated perforation may be diagnosed during colonoscopy procedure by the visualization of evident colonic wall defect or, after the completion of colonoscopy, by the visualization of leaked air in the peritoneal or retroperitoneal space. Recently, the incidence of colonoscopy-associated perforation increased because of the introduction of colorectal endoscopic submucosal dissection. Traditionally, colonoscopy-associated perforation was managed surgically. However, medical management has been introduced widely and endoscopic clipping is the most important component for the medical management of colonoscopy-associated perforation. Timely administration of antibiotics is also important. Large perforations, diagnostic colonoscopy-associated perforations, large amount of pneumoperitoneum, and severe abdominal pain have been reported to be predictive of the necessity of surgery after endoscopic clipping. Surgery should be performed if patients show clinical deterioration even after the initiation of medical management.

• Colon
• Colonoscopy
• Endoscopy
• Perforation
• Surgical instruments