Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45-60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operator’s level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providers’ clinical judgment for individual patients, and they may need to be modified based on the medical team’s level of experience and the availability of local resources.
de’Angelis N1, Di Saverio S2, Chiara O3, Sartelli M4, Martínez-Pérez A5, Patrizi F6, Weber DG7, Ansaloni L8, Biffl W9, Ben-Ishay O10, Bala M11, Brunetti F1, Gaiani F12, Abdalla S1, Amiot A13, Bahouth H10, Bianchi G1, Casanova D14, Coccolini F8, Coimbra R15, de’Angelis GL12, De Simone B16, Fraga GP17, Genova P18, Ivatury R19, Kashuk JL20, Kirkpatrick AW21, Le Baleur Y13, Machado F22, Machain GM23, Maier RV24, Chichom-Mefire A25, Memeo R26, Mesquita C27, Salamea Molina JC28, Mutignani M29, Manzano-Núñez R30, Ordoñez C30, Peitzman AB31, Pereira BM17, Picetti E32, Pisano M8, Puyana JC33, Rizoli S34, Siddiqui M1, Sobhani I13, Ten Broek RP35, Zorcolo L36, Carra MC37, Kluger Y10, Catena F38
World J Emerg Surg. 2018