Atalla, Mohamed Anwar, Rozen, Warren M., Niewiadomski, Olga Dorota, Croxford, Matthew A., Cheung, Wa, and Ho, Yik-Hong (2010) Risk factors for colonic perforation after screening computed tomographic colonography: a multicentre analysis and review of the literature. Journal of Medical Screening, 17 (2). pp. 99-102.

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Abstract

Background: Computed tomographic (CT) colonography (or ‘virtual’ colonoscopy) has become an increasingly popular tool for colorectal cancer screening. Colonic perforation, an uncommon complication, is a risk that has not been widely reported.

Methods: A systematic review of the literature was undertaken to identify all reported risk factors for colonic perforation following CT colonography. In addition, a retrospective multicentre study was undertaken, evaluating all CT colonographies in 10 major metropolitan tertiary referral centres. All colonic perforations were assessed for risk factors.

Results: A range of ‘patient’-related and ‘procedure’-related risk factors were identified in the literature. Among 3458 CT colonographies, there were two cases of colonic perforation contributing to an incidence of perforation of 0.06%. There was no statistical correlation between the incidence of perforation and institutional experience (P = 0.66). Risk factors common to both cases and the literature included age, recent colonoscopy and manual colonic insufflation. Diverticular disease and recent colonic biopsy were also notable factors.

Conclusion: There is a small but real risk of perforation following CT colonography. Patient selection and preventative procedural measures may reduce this risk. The importance of the consent process is emphasized.

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