3. Results Five female patients presented with acute iatrogenic colonic perforation, which occurred during screening colonoscopy. The mean age, mean BMI, and median ASA of the patients were 71.4 �� 9.7 years (range: 58�C83 years), 26.4 �� 3.4kg/m2 (range: 21.3�C30.9kg/m2), and 2 (range: 2-3), respectively (Table http://www.selleckchem.com/products/Sorafenib-Tosylate.html 1). Three perforations were secondary to mechanical trauma and recognized during the colonoscopy, while two perforations occurred due to thermal injury and were identified within 24 hours of the colonoscopy. The perforations were located in the sigmoid (n = 4) and cecum (n = 1). While in 3 cases the time interval between perforation and surgery was 3-4 hours, in 2 cases surgery was performed following 18 and 20 hours of perforation. Table 1 Preoperative and intraoperative parameters.

All procedures were successfully performed using pure laparoscopic technique. There was no significant blood loss (range: 0�C50mL) or intraoperative complications during the procedures, and none required conversion to open surgery. Surgical resection and diversion were not required for any of the perforations. Mean resumption of oral intake and return of bowel function, as evidenced by passage of flatus, were 1.4 �� 0.5 and 1.6 �� 0.9 days, respectively (range: 1-2 days). The average length of hospital stay (LOS) was 3.8 �� 0.8 days (range: 3�C5 days). There were no postoperative complications, and none of the patients required readmission or secondary operative intervention (Table 2). Table 2 Postoperative outcomes. 4.

Discussion Although complications during colonoscopy are uncommon, colonic perforation represents a potentially life-threatening event that may result in peritonitis, sepsis, and multiorgan failure, thus demanding prompt diagnosis and intervention [1]. While colonic perforations have traditionally been managed through emergent laparotomy with segmental resection and possible diversion, MIS techniques, including laparoscopic segmental resection or primary suture repair and endoscopic suturing or clipping, have more recently been implemented [1, 3�C7, 10�C12]. The utilization of laparoscopic modalities has demonstrated to result in diminished surgical trauma, lower conversion rates, reduced complication rates, and quicker recovery with shorter length of hospital stay compared with open surgery [5�C7].

Four main mechanisms have been hypothesized in the pathogenesis of colonoscopic perforation: direct penetration of the bowel wall, barotrauma, thermal abrasion, and traction injury [3, 13, 14]. The selection of an appropriate approach for the management of a colonoscopic perforation must be individualized on a case-by-case basis. A history of previous colonic pathology requiring AV-951 partial colectomy, such as recurrent diverticulitis or neoplastic disease, may preclude consideration of primary repair.