A common application of endoscopy is the detection and removal of gastrointestinal polyps. Polpyectomy is associated with a small but real risk of perforation. We describe a case of laparoscopic management of a duodenal perforation following endoscopic duodenal polypectomy. A 41 year old male with familial adenomatous polyposis presented for surveillance esophagogastroduodenoscopy. As a result of colonic polyposis he had undergone total proctocolectomy with ileonal pouch anastomosis and a temporary diverting iliostomy. During endoscopy he was found to have a single small sessile duodenal polyp. The polyp was elevated with epinephrine, methlyne blue and saline, injected Submucosal, and a snare biopsy of the duodena polyp was performed. In the recovery room the patient began to experience right upper quadrant abdominal pain. Surgical consultation was obtained and a CT scan revealed free intra-peritoneal air. The patient was brought to the operating room for attempted laparoscopic repair of the perforation. A Hasson technique was used to obtain pneumoperitonium at the umbilicus. One 5 mm port and two 12 mm ports were then triangulated in the upper abdomen. Following adhesiolysis, a fan retractor was placed to retract the liver and expose the stomach and duodenum. An anterior perforation of the duodenum was identified and confirmed by intra-operative endoscopy. The adjacent omentum was mobilized to perform a Graham patch of the perforation. The patient had an uneventful post-operative course and was discharged home on post-operative day six. Histology of the resected polyp revealed a duodenal adenoma without dysplasia. Free perforation of the duodenum is a known complication of endoscopic polypectomy. Surgical consultation and early recognition of the injury allows successful laparoscopic intervention and repair while limiting the potential morbidity of this complication. Previous abdominal operations are not contra-indications to laparoscopy, even in the acute setting of duodenal perforation.