Iatrogenic colon perforation is one the most morbid complications of colonoscopy. Early identification and intervention are crucial for successful minimally invasive treatment of the perforation. We are presenting a case of an iatrogenic perforation of the colon following colonoscopic intervention, managed laparoscopically. Presentation: A 55-year-old male with history of sarcoidosis on steroid underwent a screening colonoscopy with snare cautery polypectomy of 2 sessile polyps in the left colon. Ten hours later he presented to ED passing blood with bowel movement. He was tachycardic with drop of hematocrit drop from 42 to 28. He underwent colonoscopic clip hemostasis on the polypectomy sites. Mesenteric angiogram demonstrated no evidence of active bleeding. Two days later, he reported worsening abdominal pain and distention. A CT scan revealed extraluminal air bubbles near the colonoscopic clips consistent with a contained perforation. ProcedureDiagnostic laparoscopy revealed a 1x1 cm perforation at the snare cautery polypectomy site. The cecum was massively distended with an area of seromuscular tear. Intraoperative colonoscopy confirmed the single area of perforation of left colon at the area of previous polypectomy cauterization. Primary repair of the perforation was performed and the repair reinforced with the omentum. A decompressive cecostomy was performed. Patient did well and went home on POD# 5ConclusionIn hemodynamically stable patient a combined laparoscopic - colonoscopic approach is a safe and feasible modality for management of colonoscopic induced colonic perforation. Several intraoperative maneuvers are crucial for this minimally invasive approach. Laparoscopic repair associated with Enhanced Recovery After Surgery