Fig. 1. Endoscopic closure of a colonic perforation using through-the-scope clips (TTSCs). (A) Linear perforation in the sigmoid colon is observed during diagnostic colonoscopy. (B) Complete closure is achieved by applying multiple TTSCs across the defect.

Fig. 2. Purse-string closure technique with endoloop and through-the-scope clips (TTSCs) for colonic perforation using a dual-channel endoscope. Sequential images show the placement of TTSCs along the perforation margin and approximation using an endoloop for full-thickness closure.

Fig. 3. Laparoscopic management of iatrogenic colonic perforation. (A) Intraoperative identification of the perforation site (green arrow) on the antimesenteric border of the colon. (B) Successful laparoscopic primary repair of the defect with interrupted sutures.

Fig. 4. Clinical decision-making algorithm for the management of iatrogenic colonic perforation. TTSC, through-the-scope clip; OTSC, over-the-scope clip.