Perforations are known to occur after colonoscopy. In a consecutive study the localization of the perforation was determined, and the etiology of the perforation was classified as: therapeutic, barotraumatic or mechanical. A colonic perforation occurred in 26 of 19,135 patients (0.14%). In 13 cases (50.0%) the cause of perforation was mechanical, in nine (34.6%) the cause was a barotrauma (cecal blow-out), and in three cases (11.5%) it was due to a therapeutic procedure (coagulation or polypectomy). In one case (3.8%) data were not available. Cecal blow-out occurred significantly more often as a result of barotrauma, whereas perforation of the sigmoid occurred more often as a result of direct mechanical trauma. The risk of perforation after colonoscopy is rather low. Barotrauma due to insufflated air occurs more often than therapeutic perforation due to polypectomy or coagulation. Patients with a higher risk of perforation are those with diverticula in the sigmoid.
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