Advertisement

Rectal perforation during colonoscopic retroflexion: a large, prospective experience in an academic center

  • Matthew R. Quallick
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (M.R.Q.), University of Colorado Health Sciences Center, Denver, Colorado, Department of Gastroenterology (W.R.B.), Denver Health Medical Center, Denver, Colorado, USA
    Search for articles by this author
  • William R. Brown
    Correspondence
    Reprint requests: William R. Brown, MD, 660 Bannock Street, MC 4000, Denver, CO 80204.
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (M.R.Q.), University of Colorado Health Sciences Center, Denver, Colorado, Department of Gastroenterology (W.R.B.), Denver Health Medical Center, Denver, Colorado, USA
    Search for articles by this author

      Background

      Retroflexion in the rectum is performed routinely during colonoscopy in an attempt to detect lesions that could be missed by forward viewing alone. Case reports of rectal perforation caused by this procedure have been published, but the frequency of this serious complication in large series is unknown. In addition, there are few reports regarding the management of colonoscopic rectal perforations.

      Objective

      To determine the colonic perforation rate of rectal retroflexion and the management of this complication at 3 affiliated academic hospitals from July 1, 2001, to June 30, 2008.

      Design

      Multicenter case series.

      Setting

      A university hospital, a Department of Veterans Affairs hospital, and an urban safety-net hospital.

      Patients

      A diverse population of patients who underwent colonoscopy for various indications.

      Results

      Four cases of rectal perforation occurred during rectal retroflexion in a total of 39,054 consecutive colonoscopies (0.10 per 1000). One of these complications occurred in a colonoscopy performed by a supervised trainee; the other 3 occurred during colonoscopy performed by experienced faculty endoscopists alone. Three of the 4 perforations were managed successfully without surgical intervention.

      Limitations

      The complication rate relies on physician self-reporting.

      Conclusions

      Rectal retroflexion during colonoscopy is associated with a low rate of perforation, yet this serious complication can occur even in the hands of experienced endoscopists. Most cases of rectal perforation during retroflexion can be managed nonoperatively.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fu K.
        • Ikematsu H.
        • Sugito M.
        • et al.
        Iatrogenic perforation of the colon following retroflexion maneuver.
        Endoscopy. 2007; 39: E175
        • Chu Q.
        • Petros J.G.
        Extraperitoneal rectal perforation due to retroflexion fiberoptic proctoscopy.
        Ann Surg. 1999; 65: 81-85
        • Ahlawat S.K.
        • Charabaty A.
        • Bejamin S.
        Rectal perforation caused by retroflexion maneuver during colonoscopy: closure with endoscopic clips.
        Gastroint Endosc. 2008; 67: 771-773
        • Hasan A.G.
        • Brown W.R.
        A model for morbidity-mortality conferences in gastroenterology.
        Gastrointest Endosc. 2008; 67: 515-518
        • Cutler A.F.
        • Pop A.
        Colonoscopic retroflexion revisited.
        Am J Gastroenterol. 1999; 94: 1537-1538
        • Varadarajulu S.
        • Ramsey W.H.
        Utility of retroflexion in lower gastrointestinal endoscopy.
        J Clin Gastroenterol. 2001; 32: 235-237
        • Hanson J.M.
        • Atkin W.S.
        • Cunliffe W.J.
        • et al.
        Rectal retroflexion: an essential part of lower gastrointestinal endoscopic examination.
        Dis Colon Rectum. 2001; 44: 1706-1708
        • Grobe J.L.
        • Kozarek R.A.
        • Sanowski R.A.
        Colonoscopic retroflexion in the evaluation of rectal disease.
        Am J Gastroenterol. 1982; 11: 856-858
        • Saad A.
        • Rex D.K.
        The role of retroflexion in the detection of rectal disease during routine colonoscopy.
        Gastrointest Endosc. 2007; 65: AB261
        • Rex D.K.
        Maximizing detection of adenomas and cancers during colonoscopy.
        Am J Gastroenterol. 2007; 101: 2866-2877

      Linked Article

      • Retroflexion-assisted EMR in the colon with immediate closure of a procedure-related perforation
        Gastrointestinal EndoscopyVol. 72Issue 6
        • Preview
          We have read with interest the articles by Quallick and Brown1 as well as Tribonias et al2 on perforation caused by diagnostic colonoscopy in retroflexion. It is a rare complication, and the clinical experience on its nonsurgical treatment is quite poor.2-4 A retroflexed colonoscope may also facilitate the endoscopic removal of early neoplastic lesions in difficult colonic positions with retrograde fold involvement.5,6 However, there is no experience on perforation during retroflexion-assisted endotherapy.
        • Full-Text
        • PDF