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Although the incidence of iatrogenic colonoscopic perforation is low, it can result in severe complications and mortality. This study assessed the incidence and management of colonic perforations during an eight year period at a tertiary medical center in Ahmedabad (Gujarat). Methods: We reviewed all the medical records of patients received colonoscopies from January 2011 to December 2018. We collected the patient’s demographic data, colonoscopic reports, and data regarding the location of perforations, their treatment and outcome. Results: During the 8-year period, out of a total of 4650 colonoscopies, 9 cases (0.19%) involved in colonoscopic perforations (6 men, 3 women). Of the 9 perforations 6 (66%) occurred in the sigmoid colon. Out of 9 perforation 7 (77%) of perforations were treated surgically and two (23%) medically with intestinal rest and intravenous antibiotics. The two patient who were treated medically were having small perforation occurred by biopsy forceps, these people kept nil by mouth for 72 hours and antibiotics were given and watched carefully for any signs of peritonitis. Convincingly these two people did not need surgical intervention. In the group treated surgically, four patients received primary repair with proximal diversion, two received colonic diversion and one patient received resection with anastomosis. No patient of colonic perforation died in our institute. Conclusion: Iatrogenic colonoscopic perforation is a serious but rare complication. Its early recognition and treatment are essential. We found a perforation rate of 0.19%. Some patients with small colonoscopic perforations may be safely treated nonoperatively, while others with large perforation or diffuse peritonitis may require surgery.
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Background:Norfloxacin is the most commonly used agent for the prophylaxis against spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Rifaximin, another broad spectrum antibiotic, is used for the treatment of traveler’s diarrhea and hepatic encephalopathy. Objective: We aimed to test the efficacy of rifaximin versus norfloxacin for prevention of SBP in patients with hepatitis C virus (HCV)-related liver cirrhosis. Methods: 100 patients with HCV-related liver cirrhosis and ascites were included in study and divided into two groups of matching age, sex and Child–Pugh class. Group I patients were given norfloxacin 400 mg/day and group II patients were given total dose of rifaximin 1200 mg/day in three divided doses. The follow up time was one year. Results:Patients on rifaximin developed fewer episodes of SBP than those on norfloxacin (8% vs 16% respectively) although it was statistically insignificant (p=0.265). Also, the duration before developing a new attack of SBP was longer in patients treated with rifaximin as compared to those taking norfloxacin (9.0 vs. 5.5 months, respectively). Additionally, rifaximin significantly reduced the rate of new compared to past episodes of SBP by 24% (p while the rate reduction with norfloxacin was only by 18% and not statistically significant (p= 0.45). Overall survival was equal in both groups. Conclusion: Rifaximin is – at least – as good as norfloxacin. It seems to be an appropriate alternative for long-term primary and secondary prophylaxis of SBP in cirrhotic patients with ascites.
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BACKGROUND: Color Doppler is a noninvasive method for assessing portal hemodynamics. Laser Doppler velocimetry is useful in assessment of microcirculatory abnormalities in portal hypertensive gastropathy (PHG). AIMS: To study portal hemodynamics by color Doppler and gastric mucosal blood flow (GMBF) by laser Doppler velocimetry in patients with cirrhosis. METHODS: Twenty-eight patients with cirrhosis of liver (24 men) and 10 healthy subjects (7 men) were studied. Portal venous blood flow (PVBF) and portal flow velocity (PFV) were assessed by color Doppler at the level where the hepatic artery crosses the portal vein, and GMBF was measured by laser Doppler velocimetry. RESULTS: PVBF (379.5 [102.9] mL/min), PFV (5.3 [1.1] cm/sec) and GMBF (3.5 [0.8] volts) were significantly lower in patients with cirrhosis than in controls. PVBF and PFV were significantly lower in patients in Child class B and C than those in class A. Patients with ascites had significantly lower PVBF, PFV and GMBF than those without; values were also lower in patients with PHG than in those without. History of bleeding had no relation with PVBF and PFV. GMBF showed good correlation with PVBF (r=0.58, p<0.001) and with PFV (r=0.48, p<0.01). CONCLUSIONS: In cirrhosis of liver, PVBF, PFV and GMBF are significantly lower, and the changes increase with increasing severity of liver disease.