Sigmoid perforation during colonoscopy is a rare event. In recent years, endoscopic closure of the perforation defect has been developed. The Over-the-Scope-Clipping-System (OTSC) enables the closure of the defect in many cases, avoiding a surgical procedure. Nonetheless, this procedure is not free from complications, the most frequent one being treatment failure.
A 68-year-old woman with a medical history of valvular heart disease, atrial fibrillation and right diaphragmatic paralysis was diagnosed with colorectal polyps. A colonoscopy was performed during follow-up of these colorectal polyps , in which a 1 cm sigmoid perforation 25 cm from the anal verge was found.
A closure was performed with a OTSC system, during which a small bowel loop was inserted in the defect (FIG1, FIG2).
An emergent laparoscopy was performed, in which a lateral herniation of the ileal bowel into the sigmoid lumen was found. The OTSC system perforated the bowel loop which had necrotic changes. A segmental sigmoid resection with ileal resection was performed.
The postoperative course was uneventful.
The OSTC system is an useful tool for treatment of gastrointestinal perforations. with the potential to avoid the need for emergency surgery. Nonetheless the procedure should be carried out by experienced gastroenterologists to avoid complications.