Metallic clip-associated colonic perforation after peroral endoscopic myotomy: A case report

Table 1 Case timeline

Time	Event
Day 0	Peroral endoscopic myotomy was performed for achalasia. Eight metallic clips (Micro-Tech ROCC-D-26-195) were placed to close the submucosal tunnel entry
Day 3	Upper gastrointestinal contrast imaging showed normal esophageal peristalsis, a patent cardia, and multiple metallic clip shadows in the distal esophagus
Day 25	The patient developed sudden-onset severe lower abdominal pain
Day 26	Emergency admission. Physical examination revealed lower abdominal distension, tenderness, rebound tenderness, and muscular rigidity. Abdominal computed tomography demonstrated a metallic clip adjacent to a sigmoid colon perforation
Postoperative	Histopathology showed full-thickness bowel wall disruption with granulation tissue, necrosis, and inflammatory exudate at the perforation margins. A free metallic clip was found in the adjacent fecal material, consistent with localized pressure necrosis
5 months after discharge	The patient reported no discomfort and recovered uneventfully