Now, perforation. Management of perforation, of course, when you are in a procedure where you still have to resect part of the polyp, when you have a perforation, what you want to do is reduce the CO2 content of the colon, so suck the air, as my Japanese colleagues were also told me, and bring the fluids away from the lesion, give to the patient some IV anti-peristaltic agents, so that these won't interfere, the peristalsis won't interfere with the resection and the perforation closure, and finally, once resected, apply the clips as we saw. If the patient has a perforation, whether it's a delayed perforation, which many times happened that, as we saw, patient might come back to the hospital with abdominal pain or might develop this pain after a few hours for the perforation, they usually develop abdominal severe pain, distention, tendons, and guarding. Vital sign may be normal or they might have some tachycardia and they might develop fever, and for this reason, you need to give them a broad spread through antibiotics, you need to, again, organise an urgent CT scan and involve the surgical team as soon as possible, because even if the surgeon won't operate on the patient, or even if you think that the patient is doing well after you started all the antibiotics and you gave them the painkillers, it's always better to involve the surgeon so that at least they are aware of this patient in the hospital. For more information, visit www.iclinic.co.uk

colon perforation

polyp resection

CO2 reduction

anti-peristaltic agents

delayed perforation