Unexpected Delayed Rectal Perforation after Endoscopic Submucosal Dissection

Superficial gastrointestinal neoplasia may be removed endoscopically.ESD (Endoscopic submucosal dissection) isaneffectiveandsafe procedurewhich allows “en bloc” resection of superficial gastrointestinal lesions.The most common adverse events ofESD are perforation and bleeding.Late perforation are rare and occur in 0.22% according to literature.We report a case of delayedrectal perforation, occurring 16days after ESDof a 65 x 35-mm laterally spreading tumor (LST) nodular mixed type(G-MIX), ofthe rectum.The perforation wascompletely unexpected because ofabsence of post-ESD risk factors and the long period of wellness of the patient after the procedure.