Although complications can occur, colonoscopy is considered a safe procedure. The most dreaded of these is iatrogenic perforation.
The literature reports perforation rates of 0.03%-0.8% for diagnostic procedures, and a rate of 0.15%-3% for therapeutic procedures. Mechanisms of perforation are the result of either mechanical disruption of the colonic wall (e.g. thermal injury, forced push into a diverticulum, or stretching of the bowel with loops or the slide-by technique) or excessive air insufflation. After perforation, prompt abdominal surgery is usually recommended, particularly in the last few years, following the introduction of laparoscopic approaches in clinical practice. Nevertheless, conservative treatment is a feasible and effective option for patients who are clinically stable and without peritonism or life threatening signs.
A research article published on February 28, 2011 in the World Journal of Gastroenterology addresses this question. The authors reported a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.
This report underlines how a conservative approach, together with a combination of various endoscopic techniques, can resolve complicated perforations without the need for surgical intervention.