Small intestine grasped by over-the-scope-clip during attempt to close an iatrogenic colonic perforation.

The over-the-scope-clip (OTSC; Ovesco, Tübingen, Germany) has been developed for the closure of intestinal defects [1,2]. We report on the case of a misplaced OTSC, which grasped the small intestine through an iatrogenic colonic perforation. A 78-year-old women underwent followup colonoscopy after right-sited colon resection, which was performed for colon carcinoma. In the transverse colon, a flat polyp was detected. After performing the lifting procedure, a polypectomy was carried out using a snare. Immediately after polypectomy, a transmural iatrogenic perforation was observed (●" Fig.1a). The investigator immediately tried to close the perforation by applying an OTSC, using the standard procedure that involves suctioning the defect to ensure correct clip positioning. After releasing the OTSC, the small intestine was seen in the colonic lumen, with the clip fixed around it (●" Fig.1b ,●" Video 1). The patient was transferred to the surgical department for laparotomy 2 hours after the perforation event. During laparotomy, the livid color of the jejunum wall could be seen where the OTSC had grasped the small intestine. The intestinal lumen was occluded completely (●" Fig.2a). The OTSC was released using a side cutter,