Endoscopic Treatment of Iatrogenic Colon Perforation: Literature Review and Case Report

Colonoscopic perforation is a severe but rare complication of lower gastrointestinal endoscopies, linked to high morbidity and mortality rates. Iatrogenic perforation during colonoscopy can lead to serious outcomes including extended hospital stays, need for surgical intervention, intra-abdominal sepsis, or death. While perforations have traditionally required surgical or interventional radiology management, use of over-the-scope clipping has offered the option of endoscopic management. Herein we report the case of a 79-year-old woman who presented with concern for colonic perforation after endoscopic polypectomy. Colonic perforation was detected at a follow up colonoscopy. Further investigation with CT revealed findings of perforation with pneumoperitoneum. Repeat colonoscopy was performed revealing the perforation in the distal colon. During the procedure, hemostatic over-the-scope clips were placed, and the defect was successfully closed. This paper aims to highlight the incidence of perforation during colonoscopy and to discuss the role endoscopic management in bowel perforation.