Colonoscopy as detection of free air on direct

Colonoscopy is accepted as the gold standard approach for the assessment of
colorectal diseases. It has been associated with various complications,
and there is no doubt that perforation is the most
important of all (1). Iatrogenic perforation
rates during colonoscopy ranges between 0.005% and 0.63% with the larger part of patients requiring laparotomy for
repair. Colonoscopic perforation mechanisms include blunt trauma to the colonic
wall, barotrauma from air insufflation, inadvertent
endoscopic resection or intemperate warm harm (1).
The investigation made by An et al. uncovered that in the management of colonic
perforation, perforation size >15 mm is a critical
indicator for conversion from non-surgical to surgical procedures (2). So
professional skill and education level of the endoscopist come into prominence.

We report a 52-year-old lady who experienced
sigmoid perforation during diagnostic
colonoscopy. The diagnosis of perforation was made based on
clinical presentation, physical examination and radiological evidence, such as
detection of free air on direct radiography
(Fig.1). The patient was taken up for abdominal
exploration. There was no fecal matter in the peritoneal cavity. Local contamination was minimal. The perforation site was inspected and a 4-5 cm sigmoid
colon perforation was recognized (Fig.2). Resection with primary anastomosis performed. The postoperative course was uneventful and the
patient was discharged on postoperative day
7.

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To
have standard performance, endoscopist must have done at least 25-30 flexible
sigmoidoscopy and 200 colonoscopy (3). Qualification bencmarks for gastrointestinal endoscopic interventions are assessed on the premise of the number of
procedures performed. Discussion is frequently about ‘Which sort
of specialist should do colonoscopy?’. In my opinion this is a meaningless question as long as the
education given is well and quality standarts are met. A colonoscopy performed
by gastroenterologist, internist or surgeon reduces the risk for
colorectal cancer death— in any
case, when it’s performed by well
trained endoscopist, the hazard for colon perfortion
is least of
all. Cecal intubation rate >90 %, adequate bowel preparation,
post polypectomy bleeding rate of