Introduction
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The over-the-scope clip (OTSC) (Ovesco Endoscopy GmbH, Tübingen, Germany), designed for tissue approximation, is already recommended as first-line endoscopic treatment for endoscopic acute iatrogenic perforation [@JR1633-1] . To the best of our knowledge, no data regarding gastrointestinal traumatic, not iatrogenic, perforation repaired with the use of OTSC, are available.

. Case report
=============

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**Video 1**  Full-length video showing the entire successful repair of wide traumatic rectal perforation using OTSC

A 16-year-old girl was referred to the emergency room for copious rectal bleeding and secondary syncope, due to violent trauma. Computed tomography (CT) scan and subsequent colonoscopy revealed a voluminous pelvic hematoma and a 35 -- to 40-mm irregular full-thickness defect, located in the posterior rectal wall, about 30 mm from the dentate line ( [Fig. 1](#FI1633-1){ref-type="fig"} ).

![35- to 40-mm irregular full-thickness defect of the posterior rectal wall.](10-1055-a-1093-0778-i1633ei1){#FI1633-1}

Because of the lesion's features and the acute setting, an OTSC was placed (12 /6 mm, traumatic type) using the OTSC twin grasper (Ovesco Endoscopy GmbH, Tübingen, Germany) ( [Fig. 2](#FI1633-2){ref-type="fig"} ). This auxiliary device has two jaws which can be opened separately, allowing better gaping edges approximation.

![ Edges approximation with OTSC twin grasper.](10-1055-a-1093-0778-i1633ei2){#FI1633-2}

The entire procedure was performed under deep sedation, using CO ~2~ insufflation [Video 1](#ME1633-1){ref-type="media"} .

The endoscopic treatment was effective, as confirmed after contrast medium injection and CT scan.

A Few days later, second endoscopic look confirmed complete sealing of the defect and the patient was discharged home ( [Fig. 3](#FI1633-3){ref-type="fig"} ).

![ Complete sealing of the defect.](10-1055-a-1093-0778-i1633ei3){#FI1633-3}

Conclusion
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In conclusion, OTSC with a twin grasper can successfully treat wide traumatic rectal perforation, avoiding major surgery with definitive or temporary stoma, especially in a young patient.

**Competing interests** The authors declare that they have no conflict of interest.
