Management of iatrogenic perforation

• Published in: Gastroenterology clinics of North America Vol. 32; no. 4; p. 1289
• Main Authors: Putcha, Rajesh V, Burdick, J Steven
• Format: Journal Article
• Language: English
• Published: United States 01.12.2003
• Subjects: Algorithms; Colon - injuries; Endoscopy, Gastrointestinal; Humans; Intestinal Perforation - diagnosis; Intestinal Perforation - etiology; Intestinal Perforation - therapy; Intestine, Small - injuries; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Intraoperative Complications - therapy; Stomach - injuries
• ISSN: 0889-8553
• DOI: 10.1016/S0889-8553(03)00094-3

Iatrogenic perforation of the gastrointestinal tract is a medical emergency and is inevitable. An endoscopist must maintain a high index of suspicion despite minimal or atypical symptoms and negative radiologic studies, because perforation is a complication with tremendous morbidity and mortality. The endoscopist must know how to manage this complication appropriately and to seek immediate surgical consultation. There is ongoing controversy about when a patient should undergo nonoperative or surgical therapy. An evidence-based approach to manage iatrogenic perforation is not possible. The trend in the modern era is to less invasive, nonoperative therapy, given advancements in ICU care and antibiotics. Laparoscopy or laparoscopic-assisted (minilaparotomy) surgery is also being increasingly used with outcomes comparable with conventional laparotomy. Experience and advancements in accessories have enabled endoscopic repair of iatrogenic perforation in many situations [84]. The management algorithms provided synthesize the pertinent literature into reasonable guidelines to follow. Ultimately, an individualized approach must be taken to manage the patient with an iatrogenic perforation.