Closure of a rectal perforation by clipping the margins to presacral tissue

Abstract

Iatrogenic colorectal perforation during therapeutic colonoscopy is a rare but serious complication [1]. It is usually managed with immediate open surgery. However, conservative therapy has recently been advocated [2], provided that adequate precolonoscopic bowel preparation has been carried out and that no peritoneal signs are present [3]. Asymptomatic perforations after colonoscopic polypectomy have been conservatively managed using close observation, even in the presence of intra-abdominal free air [4]. Recently, endoclip closure was used to treat iatrogenic colonic perforation conservatively [5]; however, endoclipping cannot be used to repair perforations that are larger than the endoclip (diameter 11 mm) [5].