Colonoscopic Complications: Colonic Perforations

Perforation is the most dreaded complication of colonoscopy, and risk increases with therapeutic interventions. Increasing adoption of aggressive resectional procedures such as EMR and ESD further increase risk. Managing colonic perforation depends upon the extent of the injury and when recognized. Endoscopic management is possible and often successful for small perforations when noted during the index procedure. Large perforations are best addressed surgically, and primary repair is often possible when expeditiously recognized. Delayed presentation is frequent, and a high index of suspicion is essential. Non-operative management is possible; however, generalized peritonitis will warrant urgent surgical exploration and repair.