Abstract
Background and study aims Patients undergoing bowel preparation for colonoscopy are at risk of potentially
severe adverse events such as large-bowel obstruction (LBO) and perforation. These
patients usually need emergency surgery and the consequences may be fatal. Little
is known about the risk factors for LBO and perforation in these circumstances. We
sought to establish the natural history of LBO and perforation caused by oral preparation
for colonoscopy.
Patients and methods We retrospectively analyzed data from 20 patients with LBO or perforation associated
with oral preparation for colonoscopy. All patients were treated at the Showa University
Northern Yokohama Hospital (SUNYH) between April 2001 and December 2015. Drugs used
for bowel preparation, age, sex, indication for colonoscopy, pathogenesis and treatment
were recorded.
Results Eighteen of the patients had LBO and 2 had perforation. Fourteen events occurred
at SUNYH, which accounted for 0.016 % of patients who underwent bowel preparation
during this period. Seventeen patients were symptomatic when the decision to undertake
colonoscopy was made (including 7 who complained of constipation and 4 who complained
of abdominal pain; 3e were asymptomatic). Nineteen patients ultimately required surgery,
13 within 3 days of presentation. Eleven patients ultimately required colostomy. There
was no perioperative mortality in our cases.
Conclusion Large bowel obstruction and perforation are rare events associated with oral preparation
for colonoscopy, but frequently require surgery. Exacerbation of constipation might
be a risk factor for LBO or perforation. Potentially catastrophic situations can be
avoided by early detection and treatment.
