Introduction
Colonoscopy, which is one of the most commonly performed gastrointestinal endoscopic procedures, has been used for diagnostic and therapeutic purposes1. With the recent rise in colonoscopy screening and the increasing prevalence of colorectal cancer, the use of colonoscopy is steadily increasing worldwide, which also leads to an increase in colonoscopy related complications2,3. Colonoscopy is considered relatively safe1,4,5, but it can cause complications such as bleeding or perforation, especially in the elderly patients and patients with inflammatory bowel disease2. Among colonoscopy-related complications, colon perforation is the most serious complication2. A recent systematic review of 55 studies reported the risk of perforation during screening colonoscopy as 0.4 per 10,000 case6. Kim et al. reported the incidence of colon perforation as 0.5 to 8.5 per 10,000 case. Even though colon perforation rarely occurs, it can lead to serious sequelae such as death or sepsis caused by peritonitis1. From the medico-legal perspective, colon perforation often tends to be considered as a doctor’s negligence7. As a result, doctors may take the defensive attitude of rejecting high-risk patients or passively providing conservative treatment to avoid litigation8-10. Review of the medicolegal cases of medical accident can help us prevent similar accidents in the future. From this perspective, written judgments of medical lawsuits on colon perforation may provide useful information to avoid similar accidents. Until now, a few reviews of the cases on the complications of colonoscopy were mostly based on the patient medical records or insurance company records11-13, but no studies were based on the using written medical lawsuit judgments. The aim of this study is to identify the characteristics and causes of medical accidents by analyzing lawsuits on colon perforation during colonoscopy.