Colonoscopy rate of < 0.5 %, and

Colonoscopy is accepted as the gold standard technique
for the assessment of colon and distal ileum diseases. It has been associated
with various complications, and there is no doubt that perforation is the most
important of all (1). The incidence of iatrogenic colonic perforations ranges
between 0.005% and 0.63% with the majority of patients requiring laparotomy for
repair. Colonoscopic perforation mechanisms are blunt trauma to the colonic
wall, barotrauma from air insufflation, unintentional endoscopic resection or
excessive thermal injury (1).The study made by An et al. revealed that in the
management of colonic perforation, perforation size >15 mm is a significant
predictor 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
woman who experienced sigmoid perforation during
diagnostic colonoscopy. The diagnosis of perforation was made based on
clinical presentation, physical examination and radiologic evidence, such as
detection of free air on simple radiography (Fig.1). The patient was taken up
for emergency laparotomy. No fecal
matter was identified in the peritoneal cavity. Local peritonitis was mild. 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 from the hospital 1 week
after admission.

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To
have standard performance, endoscopist must have done at least 25-30 flexible
sigmoidoscopy and 200 colonoscopy (3). Qualification standards
for gastrointestinal procedures are assessed on the basis of the number of
endoscopic procedures performed. Discussion is often
about ‘Which type of doctor 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— but when it’s performed by well trained endoscopist,
the risk for colon perforation is lowest of all. Cecal intubation rate
>90 %, adequate bowel preparation, post polypectomy bleeding rate of

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