Closure of a duodenal perforation with an over-the-scope clip complicated by colon entrapment (with video)

An 80-year-old woman underwent ERCP for choledocholithiasis. While positioning the duodenoscope, a perforation occurred in the inferior duodenal bulb (A). The perforation site was assessed with a gastroscope, and an over-the-scope clip (OTSC, Ovesco Endoscopy, Tübingen, Germany) successfully closed the defect, which was confirmed with injection of contrast material under fluoroscopy. On further inspection, a segment of bowel appeared entrapped within the clip (B). The ERCP was completed without further adverse events.