Endoscopic closure of a rectal diverticulum perforation during a diagnostic colo- noscopy

Finding of rectal diverticula is particularly infrequent, with a frequency < 0.1% of cases of diverticulosis (1). The risk of colonic perforation ranges from 0.005% and 0.7% with differences between diagnostic and therapeu- tic procedures (2). Perforation of a rectal diverticulum during a colonoscopy has been described in only one re- port (3). Managements of endoscopic perforation vary from conservative treatment to surgical intervention with the majority of patients requiring laparotomy for repair the defect. Immediate closure of a perforation is manda- tory to limit bacterial contamination and consequent sep- sis. Endoscopic closure of an iatrogenic perforation smaller than 20 mm is performed both with Through- The-Scope (TTS) clipping-devices and Over-The-Scope Clips (OTSC) System. Both techniques are likely to be effective with similar success rates (93% and 89% re- spectively)(4). The most recent endoloop/clips tech- nique, successfully used for the first time by Endo et al. (5) to close gastric perforations, in some reports has been documented to have satisfactory results in closing iatrogenic perforations (6). In this report, we describe a successful repair of a rectal perforation caused by the maneuver of retro-flexion of the colonoscope during a diagnostic colonoscopy by using the endoloop/clips tech- nique.