Small Bowel Perforation

*Endoscopy in Small Bowel Diseases*

[33] Smyth R, Richardson C. A

2017;99:178.

method for performing intraoperative enteroscopy. Ann R Coll Surg Engl.

[34] Pontane S, Pironi D, Arcieri S, Eberspacher C, Panarese A, Filippini A. Intraoperative enteroscopy by standard

[35] Meister TE, Nicki NJ, Park A. Laparoscopic-assisted panenteroscopy. Gastrointest Endosc. 2001;53:236-9.

[36] Manatsathit W, Khruchareon U, Jensen DM, Hines OJ, Kovacs T, Ohning G, et al. Laparotomy and intraoperative enteroscopy for obscure gastrointestinal bleeding before and after the era of video capsule endoscopy and deep enteroscopy: a tertiary center experience. Am J Surg.

[37] Bonnet S, Douard R, Malamut G, Cellier C, Wind P. Intraoperative enteroscopy in the management of obscure gastrointestinal Bleeding. Dig

Enterovaginal fistula as a complication

[39] Goldstein JL, Eisen GM, Lewis B, Gralnek IM, Aisenberg J, Bhadra P, et al. Small bowel mucosal injury is reduced in healthy subjects treated with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol

[40] Gerson LB. Outcomes associated with deep enteroscopy. Gastrointest Endosc Clin N Am. 2009;19:481-96.

Liver Dis. 2013;45:277-284.

[38] Krisham RS, Kent RB III.

of intraoperative small bowel endoscopy. Surg Laparosc Endosc.

2018;215:603-609.

1998;8:388-9.

Ther. 2007;25:1211-22.

contamination technique. Surg Laparosc Endosc Percutan Tech. 2013;23:e11-3.

colonoscope with a minimal

**106**

**109**

**Chapter 7**

**Abstract**

Perforation

*and Meraj Ahmed*

small bowel endoscopy

the goal followed by prompt surgical correction.

**bowel endoscopy/enteroscopy**

**1. Introduction**

Early Recognition and

Management of Small Bowel

*Md. Yusuf Afaque, Noha Rehman, S. Amjad Ali Rizvi* 

**Keywords:** small bowel perforation, peritonitis, laparoscopy, enteroscopy,

Enteroscopy has a procedure-related perforation rate from less than 1% to 6.5%. It seems to be higher in therapeutic enteroscopy, especially polypectomy of large polyps, and in patients who have altered surgical anatomy. Early recognition is lifesaving and studies have shown that if surgery is done within 12 hours of perforation the prognosis is better. In a patient who has undergone small bowel endoscopy the diagnosis of small bowel perforation should be suspected if the patient has acute pain in the abdomen. Early diagnosis should be the goal with prompt surgical correction.

Enteroscopy has a procedure-related perforation rate from less than 1% to 6.5% [1–3]. It seems to be higher in therapeutic enteroscopy, especially polypectomy of large polyps, and in patients with altered surgical anatomy. Early recognition is life-saving and surgery performed within 12 hours carries a better prognosis. It was seen in peptic perforations that a delay of more than 24 hours increased mortality seven to eight times, complication rate to three times, and length of hospital stay to two times, compared with a delay of 6 hours or less [4]. Early diagnosis should be

**2. Bowel pathologies that increase the risk of perforation during small** 

Bowel pathologies with increased susceptibility for perforation during small bowel endoscopy include – Crohn's disease, anastomotic stricture, radiation stricture, altered surgical anatomy (ileoanal, ileocolic anastomosis), and intestinal lymphoma. The perforation rate during double balloon enteroscopy is seen more with the retrograde technique compared to anterograde [5]. Also, more perforations are seen with therapeutic procedures like polypectomy of large polyp (> 3 cm), argon plasma coagulation for AV malformations, and dilations of small bowel strictures [3, 5, 6]. Furthermore, endoscopy associated perforations are more in patients
