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Colon perforation during colonoscopy, colon cancer

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Crohn's Disease
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Posted 12/20/2017 4:19 AM (GMT 0)
I am long overdue for a colonoscopy to look for colon cancer. But I heard about colon perforation during colonoscopy. Have you heard or experienced colon perforation during the colonoscopy procedure? I mean even if the risk is 1%, I do not want to take it.

Now, another related questions: how many members here with Crohn's Disease who have developed colon cancer (dysplasia)? I never saw any members here on this forum who mentioned that he or she had colon cancer from Crohn's. So I would presume it is rare?
Posted 12/20/2017 4:33 AM (GMT 0)
I did some basic research and found that patients with Crohn's disease had an increased risk of colon cancer (relative risk, 2.59; 95 percent confidence interval, 1.54-4.36).

https://www.ncbi.nlm.nih.gov/pubmed/17308939

If a person without Crohn's has a lifetime risk of colon cancer of 4.7%, then a Crohn's person would have a lifetime risk of approximately 12% (of developing colorectal cancer).
Posted 12/20/2017 1:28 PM (GMT 0)
This is from a journal article of a study in 2009:
A total of 228 perforations were diagnosed after 277,434 colonoscopies, which corresponded to a cumulative 7-day incidence of 0.082%. The OR of getting a perforation from a colonoscopy compared with matched controls (n = 1,072,723) who did not undergo a colonoscopy was 27.6 (95% CI, 19.04-39.92), P < .001. On multivariate analysis, when comparing the group that had a perforation after a colonoscopy (n = 216) with those who did not (n = 269,496), increasing age, significant comorbidity, obstruction as an indication for the colonoscopy, and performance of invasive interventions during colonoscopy were significant positive predictors. Performance of biopsy or polypectomy did not affect the perforation risk. The rate of perforation did not change significantly over time.

So your risk of colon cancer is dramatically higher than your risk of perforation. But in answer to your question, my niece did experience a perforation during her last colonoscopy. She developed a high fever and needed high dose antibiotics, but the perforation repaired itself and she didn't need surgery. I think that surveillance for Crohn's disease and cancer is necessary and the benefits outweigh the risks.
Posted 12/20/2017 7:22 PM (GMT 0)
We have had multiple people on the UC board who have had to have surgery due to cancerous changes. As for perforation, I've never had one, and I've had a lot of scopes. I think I saw one person once mention a perforation, but I am not even sure of that.
Posted 12/20/2017 8:55 PM (GMT 0)
I have had more scopes than i can remember & never had an issue either. Are you having some anxiety over having one done?
Posted 12/21/2017 1:22 AM (GMT 0)
I've had a bunch of colonoscopies as well over the years and so far no issues. I even had two dilation procedures which come with added risk. The GI I go to brought up the risks at one point and discussed how they are real risks but they are very low and to sum up his perspective the main thing was being cautious and know your (the doctor's) limits. For someone with crohns the risks of not having them and going unmonitored is much much higher.
The best thing to do would be to meet with the doctor and discuss your concerns with them.
Posted 12/21/2017 2:47 AM (GMT 0)
Thank you everyone for the replies. I will meet my GI next week to discuss. I have had three colonoscopies in the last 25 years, with the last one in 2003. I am worried about about the possibility of colon perforation (I know it is low). I view colon perforation just as bad as being hit by a car, or worse. The sheer thought of colon perforation would make me quivering.
Posted 9/12/2019 6:12 PM (GMT 0)
Me too. And that’s why I avoided them. But I was diagnosed with crohns via CT scan and colonoscopy was recommended for follow up. Although doc saw deformed cecum and ulcerated ileocecal valve, he took biopsies to rule out cancer. Just found out I have cancer. I was too scared to get one all my life and now I feel bad I didn’t! I asked him to double check to see if the pathologist made a mistake. All my liver tests and bloodwork are good!
Posted 9/12/2019 6:43 PM (GMT 0)
Chigwaya: I am confused about your post. You wrote "Just found out I have cancer". What do you mean? Did the pathologist see "dysplasia" in your cecum?
Posted 9/13/2019 5:10 AM (GMT 0)
Well, my story is that I was visiting family in Indonesia this summer. I kept having pain in my upper abdominal area, spasms/contractions. I was exhausted. After awhile, the pain seemed to be mostly in my right lower quadrant. Since I was on a small island where the medical care isn't as advanced as other places, we flew to Malaysia (my husband was teaching there anyway so we went early). I explained to the GI i thought i had appendicitis because I've had this pain in the past. After his physical exam, he didn't think i had it but had me get a very extensive CT scan. Radiologist said it was crohns, but the doctor said crohns doesn't come on so fast, and i'd have to be on lots of drugs, so he gave me flagyl and cipro to treat what he thought was an infection...even though the report said my terminal ileum, the ileocecal valve, and the cecum had thickening up to 1.7 cm (normal bowel wall is 3 mm). It continued to get worse but i was back on the small island with not great medical care. Fast forward to two weeks ago when I arrived home...I immediately followed up with a colonoscopy (i'm 60, have had IBS since i was 17 and never had a colonoscopy because i'm so afraid of perforating). The doctor said he thought is was crohns but took biopsies from all sections of the intestine. He noted a lot of ulcerations in the IC valve and couldn't get through to the terminal ileum (explains why i had stopped pooping weeks ago and why i had mostly liquids since eating hurt me). He said testing to rule out cancer and tuberculosis (since it can show up in the intestine). Got a call a week later with the news it was actually cancer. The doctor was surprised by the pathology report too....I'm seeing him tomorrow to ask if it's possible to have both crohns and cancer. Or if this was just cancer. I don't know....all i know is i needed the colonoscopy to find this out because the CT scan could only tell so much. I'm still reeling with the info and have had many more tests since. Still have the endoscopy to go before i'm referred to the surgeon. :-(
Posted 9/13/2019 1:16 PM (GMT 0)
So the colonoscopy did not see any polyps and you does not have stool with blood, which mean cancer could be in early stage and treatable. It is rare to have cancer in small intestines, though it happens sometimes. Sorry to hear about it, but at least you are close to retirement age and does not have to work to make a living, so you can focus on your health.
Posted 9/13/2019 1:41 PM (GMT 0)
Hahaha...where I live in California, retirement age is much later. It’s expensive. The good thing is we bought our house 25 years ago and the value is higher, so I think of it like an ATM 😁
I’m a wuss with any procedure and freaked out about surgery. Also they’ll have to rebuild my ileocecal valve...how is that done? I’ll have my usual thousands of questions for the surgeon before surgery. I have to get an endoscopy next week because they found some cells in the IC valve that come from the stomach and need to rule out gastric cancer. Otherwise the CT scan said it wasn’t a metastatic mass.
I have a great job and compassionate boss...I work for a juice company. I do a lot of work from home. So I’ll just have to train someone soon to do my work. I have a great supportive family and an incredible circle of friends who give me laughter and love. And these online groups, where you don’t really know anyone but the sharing of stories, fears, successes, hardships...it’s supportive too.
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