Brief reportRectal perforation caused by retroflexion maneuver during colonoscopy: closure with endoscopic clips
Section snippets
Case report
A 60-year-old healthy white woman underwent colonoscopy for age-appropriate colorectal cancer screening. The findings of a physical examination, including digital rectal examination, were normal. The colon and the rectum appeared normal on colonoscopy. Retroflexion of the colonoscope within the rectal vault revealed normal mucosa and structures. On straightening the scope, a 1- to 1.5-cm tear of the anterior rectal wall was visualized approximately 6 to 7 cm from the anal verge (Fig. 1A). The
Discussion
Retroflexion injury to the rectum results from the mechanical trauma of the endoscope. Despite concerns for perforation during retroflexion in the rectum, in particular in the context of active or chronic proctitis, such a complication is rare.3 Only 3 cases of rectal perforation secondary to retroflexion are reported in the literature.3 All reported cases were managed conservatively, with successful outcomes. All patients had a clean rectum, with rectal injury below the peritoneal reflection.
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Cited by (35)
Closing Perforations and Postperforation Management in Endoscopy: Duodenal, Biliary, and Colorectal
2015, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :These emphysemas usually resolve in a matter of days. Defect closure using TTS clips and OTS clips can be effective.18–22 Iatrogenic perforations are serious adverse events that can carry high morbidity and mortality, especially when more worrisome complications develop.
Retroview colonoscopy
2013, Gastroenterology Clinics of North AmericaCitation Excerpt :The inability to freely retroflex in the rectum is caused by the radius of the tip deflection being greater than the spatial capacity of the rectal ampulla so that the tip is constrained and catches the wall, impairing free movement. Perforations related to rectal retroflexion have been reported6–12 that are generally caused by a contracted rectal vault or advancing the instrument against resistance. Saad and Rex1 made a point that this maneuver should not be attempted if the rectum seems narrow.
A comprehensive approach to the management of acute endoscopic perforations (with videos)
2012, Gastrointestinal EndoscopyEndoscopic management of colonoscopic perforations (with videos)
2011, Gastrointestinal EndoscopyCitation Excerpt :Avoid retroflexion in patients with small rectums.82 Examine the rectal vault before endoscope withdrawal from the colon, because retroflexion-induced perforations could be identified and closed immediately with clips.48,49,83-86 Details of procedure duration, technical difficulties, and measures undertaken to overcome them should be noted to plan future endoscopies.
Retroflexion-assisted EMR in the colon with immediate closure of a procedure-related perforation
2010, Gastrointestinal EndoscopyComplications of Colonoscopy: Magnitude and Management
2010, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :For example, many cases of postpolypectomy bleeding can be controlled with mechanical hemostasis (eg, clips or detachable loops) or electrocautery techniques.79,81 Small perforations noted at the time of endoscopy can sometimes be successfully closed with clips,82,83 although careful observation is warranted and antibiotics may be appropriate. Generally, surgical consultation is also advised.