Treatment of pneumo-peritoneum, as a result of colonscopic perforation in a young patient is –
Correct Answer: Closure + lavage
Description: Perforation is the most common major complication after either diagnostic or therapeutic colonoscopy. Management Management of colonoscopic perforation depends upon the size of the perforation, the duration of time since the injury, and the overall condition of the patient A large perforation recognized during the procedure requires surgical exploration. Because the bowel has almost always been prepared prior to the colonoscopy, there is usually little contamination associated with these injuries and most can be repaired primarily. If there is significant contamination, if there has been a delay in diagnosis with resulting peritonitis, or if the patient is hemodynamically unstable, proximal diversion with or without resection is the safest approach. Occasionally, a patient will develop abdominal pain and localized signs of perforation after what was thought to be an uneventful colonoscopy. Many of these patients will have a "microperforation" which will resolve with bowel rest, broad-spectrum antibiotics, and close observation. Evidence of peritonitis or any deterioration in clinical condition mandates exploration. Similarly, free retroperitoneal or intraperitoneal air may be discovered incidentally after colonoscopy. In a completely asymptomatic patient, this finding is thought to result from barotrauma and dissection of air through tissue planes without a free perforation. Many of these patients can be successfully treated with bowel rest & broad-spectrum antibiotics. Surgical exploration is indicated for any clinical deterioration. Ref : Schwaz 9/e p1069
Category:
Anatomy
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