eP528 Laparoscopic approach to Lower GI endoscopy perforation; a minimally invasive solution

Aims We aim to share our experience of management of post colonoscopy perforation of sigmoid colon via minimally invasive approach and treatment options used in the case. Patient was admitted following sigmoid perforation noted during colonoscopy. He was consented for laparoscopy, laparotomy, bowel resection and stoma formation following CT imaging showing significant pneumoperitoneum. After initial diagnostic laparoscopy, showing purulent peritonitis, the perforation was repaired with non-absorbable sutures. Pelvic washout with drain placement and defunctioning ileostomy were done. Results The patient had uneventful post op recovery and was discharged on 4th post operative day following stoma training and removal of pelvic drain. He is booked for routine outpatient follow-up to discuss restoration of intestinal continuity. Conclusion Laparoscopy offers safe and effective diagnostic and definitive treatment modality for managing colonoscopy perforations and can supersede open approach in carefully selected cases. Primary laparoscopic repair can be a feasible alternative to major colonic resection in stable patients with minimal contamination but requires expert and individualised decision making. Key Statement The benefits of laparoscopy in emergency colorectal surgery are yet to be fully realised. The relatively reduced patient morbidity of this minimally invasive approach in experienced hands gives it significant advantage over open surgery.