Kolonoskopiye bağlı iatrojenik kolon perforasyonu olgularımızın değerlendirilmesi

Giriş ve Amaç: Kolonoskopik perforasyonlar nadir görülen komplikasyonlardır. Biz bu çalışmamızda kolonoskopi ile iatrojenik kolon perforasyonu tanısı konulan hastaların değerlendirilmesi amaçladık. Gereç ve Yöntem: Çalışmada Kafkas Üniversitesi Tıp Fakültesi Genel Cerrahi Endoskopi Ünitesinde Ocak 2008-Aralık 2017 tarihleri arasında kolonoskopi yapılan hastalar arasından iatrojenik kolon perforasyonu tanısı konulanlar retrospektif olarak değerlendirildi. Kolonoskopi sırasında ve sonrasında iatrojenik kolon perforasyonu belirlenen olguların demografik özelliklerinin yanı sıra klinik bulgular ve yapılan cerrahi girişimler takipleriyle birlikte kaydedildi. Bulgular: Endoskopi ünitemizde 1712’si erkek, 1850’si kadın olmak üzere toplam 3562 hastaya kolonoskopi yapıldığı belirlendi. Bunun 2561 tanesi total kolonoskopi, 1001 tanesi rektosigmoidoskopi idi. Bu olguların 300 tanesine polip eksizyonu, 858 tanesine kolon biyopsisi yapıldı. Toplam 8 hastada iatrojenik kolon perforasyonu meydana geldi. Hastaların 7 tanesine işlem esnasında, 1 tanesine ise 24 saat sonra kolon perforasyonu tanısı konuldu. Kolonoskopi sırasında kolon perforasyonu tespit edilen hastalardan 5 tanesine primer kolorafi, 1 tanesine primer kolografi ve ince barsak rezeksiyon anastomozu ve geriye kalan birine ise Hartmann prosedürü uygulandı. Konoskopi işleminden 24 saat sonra kolon perforasyonu saptanan diğer hastaya da Hartmann prosedürü uygulandı. Sonuç: Kolonoskopi esnasında çeşitli predispozan nedenlerle perforasyon görülebilir. Perforasyonu olan hastalara erken dönemde primer onarım tercih edilirken, geç dönemde stoma açılmalıdır. Deneyimli merkezlerde konservatif tedavi de yapılabilir.

Anahtar Kelimeler:

Kolonoskopi, perforasyon, iatrojenik

Evaluation of patients with Iatrogenic colon perforation caused during colonoscopy

Background and Aims: Perforations developing during colonoscopy are rare. The aim of this study was to evaluate patients diagnosed with iatrogenic colon perforation caused during colonoscopy. Materials and Methods: We retrospectively evaluated patients who had been diagnosed with iatrogenic colon perforation caused during colonoscopy at the Kafkas University Faculty of Medicine’s General Surgery Endoscopy Unit between January 2008 and December 2017. Demographic features, clinical findings, surgical intervention details, and follow-up data of the patients diagnosed with iatrogenic colon perforation during or after colonoscopy were recorded. Results: A total of 3,562 patients consisting of 1,712 males and 1,850 females had undergone colonoscopy at our colonoscopy unit. These procedures consisted of 2,561 total colonoscopies and 1,001 rectosigmoidoscopies. Polyp excision was performed in 300 and colon biopsy in 858 patients. Iatrogenic colon perforation developed in 8 patients in total, and the diagnosis was made during the procedure in 8 patients and 24 h later in 1 patient. Among those patients diagnosed during colonoscopy, primary colorrhaphy was performed in 5 patients, primary colography with intestinal resection anastomosis was performed in 1 patient, and the Hartmann procedure was performed in the remaining patients. The Hartmann procedure was also performed in the patient diagnosed with colon perforation 24 h after colonoscopy. Conclusion: Perforation can develop due to various predisposing conditions during colonoscopy. Primary repair is indicated in the early period and a stoma in the late period in these cases. Conservative treatment can also be used in experienced centers.

Keywords:

Colonoscopy, perforation, iatrogenic,

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