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Predictors of mortality and stoma formation after colonoscopic perforations

The most recent issue of the Archives of Surgery evaluates the outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations.

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Dr Anthony Yuen Bun Teoh and colleagues from China performed a retrospective review of all patients with colonoscopic perforations managed in hospitals within the Eastern New Territories region in Hong Kong.

The research determined the predictors of mortality and stoma formation in patients with colonoscopic perforations.

The research team conducted a retrospective computer-based review using data from 1 university teaching hospital, and 2 district hospitals.

The team reviewed the outcomes of patients with colonoscopic perforations surgically managed between 1998 and 2005.

Predictors of mortality and stoma formation were identified with multivariable analysis.

The team’s main outcome measures included mortality and stoma rates, and their predictors.

A total of 37,971 colonoscopies were performed during the study period, and 43 colonoscopic perforations were identified.

The overall perforation rate was 0.1%
Archives of Surgery

The overall perforation rate was 0.1% and represented a decreasing trend.

The team observed no significant difference in the perforation rate between gastroenterologists, and surgeons.

Perforations that occurred during diagnostic colonoscopies were significantly larger than those that occurred during therapeutic colonoscopies, and the patients presented earlier.

The research team found that surgical intervention was performed in 39 patients.

The overall morbidity and mortality rate was 48% and 26%, respectively.

The researchers found that stoma rate was 39%.

The predictors of stoma formation include moderate to severe peritoneal contamination and the presence of malignant colonic neoplasms.

The predictors of mortality include American Society of Anesthesiologists class 3 or higher, and antiplatelet therapy.

Dr Yuen Bun Teoh’s concludes, “Colonoscopic perforations were in a decreasing trend.”

“Patients with predictors of mortality should not be treated conservatively.”

“Other options of large bowel investigations should be considered in high-risk patients when the potential diagnostic yield is low.”

 

Arch Surg 2009: 144(1): 9-13


23 January 2009

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