Supplementary Material for: Laparoscopic treatment of iatrogenic serosal lacerations during colonoscopy – case report of a rare complication

Introduction
Iatrogenic colonic perforation following diagnostic colonoscopy is rare (0.016-0.8%) but carries significant morbidity. Reported mechanisms include direct mechanical injury, thermal damage or barotrauma. Management options range from immediate endoscopic treatment to surgical intervention or clinical observation.
Case Presentation
A 49-year-old asymptomatic female patient underwent a screening colonoscopy. During the procedure, altered mucosal perfusion of the ascending colon was suspected, prompting referral to the Emergency Department. Imaging revealed a large pneumoperitoneum. Diagnostic laparoscopy identified serosal lacerations of the ascending colon with a punctiform perforation. An invaginating suture was performed to reinforce the fragile areas of the colon. The postoperative course was uneventful, and the patient remained asymptomatic at 10-month follow-up.
Discussion/Conclusion
Serosal laceration is a rare complication, usually related to increased intraluminal pressure during colonoscopy. In the presence of atypical endoscopic findings, hyper pressure-related injury should be considered. Early recognition is essential to reduce the morbidity associated with iatrogenic colonic perforation.