Surgical Management of Iatrogenic Perforation of the Gastrointestinal Tract: 15 Years of Experience in a Single Center

• Published in: World journal of surgery 2017-08, Vol.41 (8), p.1961-1965
• Main Authors: Holmer, Christoph, Mallmann, Christoph A., Musch, Marlis A., Kreis, Martin E., Gröne, Jörn
• Format: Article
• Language: English
• Subjects: Abdominal Compartment Syndrome; Abdominal Surgery; Aged; Cardiac Surgery; Complications; Demographics; Demography; Dindo Classification; Endoscopic Procedure; Endoscopy; Endoscopy, Gastrointestinal - adverse effects; Esophageal Perforation; Female; Gastrointestinal Perforation; Gastrointestinal tract; General Surgery; Geriatrics; Humans; Iatrogenesis; Iatrogenic Disease; Intestinal Perforation - epidemiology; Intestinal Perforation - surgery; Intestine; Male; Management; Mediastinitis; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Older people; Original Scientific Report; Parameter identification; Perforation; Peritonitis; Regression analysis; Retrospective Studies; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-3986-7

Background Gastrointestinal (GI) tract perforation during endoscopy is a rare but severe complication. The aim of this study was to determine predictors of morbidity and mortality after iatrogenic endoscopic perforation. Materials and methods All cases with iatrogenic endoscopic perforation receiving surgery at a tertiary referral center in a 15-year period (2000–2015) were retrospectively analyzed. Demographics, type of endoscopy, site of perforation, operative procedure, morbidity and mortality were analyzed. Multiple logistic regression was used to identify parameters predicting survival. Results A total of 106.492 endoscopies were performed, and 82 (0.08%) patients were diagnosed with GI perforation. Most perforations (63.4%) occurred in the lower GI tract, compared to 36.6% in the upper GI tract. In 21 cases (25%), perforation was noticed during endoscopy, whereas 61 perforations (75%) were diagnosed during the further clinical course. Operative care was applied within 24 h in 61%. Surgery of perforations was almost completely performed maintaining the intestinal continuity (68%), whereas diversion was performed in 32%. Mortality was associated with age above 70 (OR 4.89, p  = 0.027), ASA class > 3 (OR 4.08, p  = 0.018), delayed surgery later than 24 h after perforation (OR 5.9, p  = 0.015), peritonitis/mediastinitis intraoperatively (OR 4.68, p  = 0.031) and severe postoperative complications with a Clavien–Dindo grade ≥III (OR 5.12, p  = 0.023). Conclusion The prevalence of iatrogenic endoscopic perforation is low, although it is associated with a serious impact on morbidity and mortality. Delayed management worsens prognosis. To achieve successful management of endoscopic perforations, early diagnosis is essential in cases of deviation from the normal post-interventional course, especially in elderly.