A case of iatrogenic colon perforation closed with an Over-The-Scope-Clip (OTSC) 24 hours later

An 85-year-old woman who tested positive for fecal occult blood underwent lower gastrointestinal endoscopy for further investigation. During the procedure, a 1-cm mechanical perforation occurred around multiple sigmoid colon diverticula. Peritonitis was localized, and since our institution did not routinely stock OTSC, conservative management was initially attempted. However, since no improvement in symptoms was observed the day after the perforation, endoscopic closure using OTSC was performed and the procedure was successful. While OTSC closure is typically performed immediately post-perforation, this case suggests that even in facilities that have no OTSC on standby, closure could be feasible the day after perforation in certain cases.