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Zeng X, Gong FR, Li Q, Shi YB, Lin F. Endoscopic closure of a giant iatrogenic sigmoid perforation using through-the-scope clips and a nylon loop: A case report. World J Gastroenterol 2027; 33(3): 124434 [DOI: 10.3748/wjg.124434]
World J Gastroenterol. Jan 21, 2027; 33(3): 124434 Published online Jan 21, 2027. doi: 10.3748/wjg.124434
Endoscopic closure of a giant iatrogenic sigmoid perforation using through-the-scope clips and a nylon loop: A case report
Xu Zeng, Fu-Rao Gong, Quan Li, Yong-Bo Shi, Feng Lin
Xu Zeng, Fu-Rao Gong, Yong-Bo Shi, Feng Lin, Department of Colorectal Surgery, Zigong Hospital of Traditional Chinese Medicine, Zigong 643000, Sichuan Province, China
Quan Li, Department of Radiology, Zigong Hospital of Traditional Chinese Medicine, Zigong 643000, Sichuan Province, China
Author contributions: Zeng X designed the study, drafted the manuscript, and managed the clinical case; Gong FR performed the endoscopic procedure and managed the clinical case; Li Q conducted the literature review and acquired the data; Shi YB and Lin F critically revised the manuscript for important intellectual content; and all authors have read and approved the final manuscript.
AI contribution statement: AI tools were used solely for language polishing assistance. No AI tool was used to generate research data, interpret results, or formulate conclusions. All AI-generated content was critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Xu Zeng, MM, Attending Physician, Department of Colorectal Surgery, Zigong Hospital of Traditional Chinese Medicine, No. 1000 Longhui Avenue, Ziliujing District, Zigong 643000, Sichuan Province, China. zengxu454527344@163.com
Received: June 16, 2026 Revised: August 7, 2026 Accepted: September 10, 2026 Published online: January 21, 2027 Processing time: 151 Days and 18.7 Hours
Abstract
BACKGROUND
Iatrogenic colonic perforation is a rare but serious adverse event during colonoscopy. Giant perforations are even rarer and generally require surgical repair. However, to date, successful endoscopic management of these giant perforations has been reported in only a few cases.
CASE SUMMARY
A 70-year-old woman was admitted for elective surgery for hemorrhoids and an anal fissure. Preoperative colonoscopy for hematochezia resulted in a diagnosis of giant iatrogenic sigmoid perforation measuring 5 cm × 4 cm. Given that the patient had received adequate bowel preparation and was in good general condition, primary endoscopic closure of the perforation was attempted. The defect was successfully closed using a single-channel therapeutic colonoscope, through-the-scope clips, and a nylon loop. Postoperative abdominal computed tomography confirmed successful closure. The patient recovered uneventfully and remained asymptomatic, with normal physical examination findings at the 3-month follow-up.
CONCLUSION
This case demonstrates successful closure of a giant iatrogenic sigmoid perforation using a single-channel therapeutic colonoscope, through-the-scope clips, and a nylon loop.
Core Tip: Iatrogenic colonic perforations are rare, particularly those involving giant defects. For iatrogenic colonic perforations > 3 cm, surgical intervention is typically prioritized because attempting endoscopic closure entails substantial risks and technical challenges, and reported successes of this approach remain exceedingly scarce. We report the successful use of a single-channel therapeutic colonoscope using through-the-scope clips and a nylon loop for the endoscopic closure of a giant iatrogenic sigmoid perforation (5 cm × 4 cm), an approach that may serve as a clinical reference for endoscopists.
