Delayed successful treatment of iatrogenic colon perforation using an over-the-scope clip

Over-the-scope clip closure of iatrogenic gastrointestinal tract perforations has been successfully demonstrated, and is usually performed in the immediate peroperative setting [1,2]. We report the first case, to our knowledge, of delayed successful treatment of an iatrogenic colon perforation using an over-the-scope clip. An 80-year-old woman underwent routine colonoscopy. Her medical history was unremarkable apart from unexplained thrombocytopenia (40000 platelets/dL). During endoscopy, a perforation occurred at the level of the sigmoid junction with the left colon (●" Fig.1). At that time, after multidisciplinary discussion, and in view of the successful colonic preparation and the thrombocytopenia, a mini-invasive endoscopic treatment was proposed (the patient being on antibiotics). Two and a half hours later the patient was transferred to our unit for an attempt at clip closure. Using a gastroscope and CO2 insufflation, a 7-mm perforation orifice was visualized. An OTSC 11/6t clip (Ovesco Endoscopy GmbH, Tubingen, Germany) was then delivered, with aspiration of the edges of the orifice (●" Fig.2, ●" Fig.3). Contrast medium study through the endoscope performed at that time did not show any fluid extravasation (●" Fig.4). The day after the procedure, the patient presented localized peritoneal irritation and fever (38°C). Lab tests showed no hyperleukocytosis, but the C-reactive protein level had increased to 204U/L. Spiral CT with bowel opacification performed then confirmed a sealed clip closure with no free fluid or air in the peritoneal cavity (●" Fig.5). The patient was kept fasting until bowel transit was re-established 2 days later. She was symptom-free by the Fig.4 Watertight closure with no extravasation of contrast medium.