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Introduction: Endoscopic colonic injury occurs in < 1% and may require surgical intervention. Mortality in Scandinavian studies is 0-0.06% after colonoscopy. Materials and methods: All claims to the Danish Patient Insurance Corporation from 1995-2005 were analysed. Indication, procedure, injury and course were registered. Results: 111 had injury by colonoscopy and 11 by sigmoidoscopy in 46 departments. 80% were ASA I-II. Indications were symptoms (63%), postoperative follow-up (7%), polyp (27%) or colitis surveillance (3%). 63% had polypectomy. Three had splenic injury and underwent splenectomy. The commonest site of perforation was the sigmoid (61%). The injury was diagnosed immediately in 28%, and after 24 hours (range 8-240) in the remainder. Treatment of perforations included suture with ileostomy (9%) or without ileostomy (29%), resection and anastomosis with enterostomy (12%) or without enterostomy (46%). Five had intraoperative splenic injury. 31% had complications, 15% required reoperation. One suffered a stroke, and one died after 17 days. Hospital stay was 29 days median (3-203). 42% required intensive care for 7 days (1-56). Complications were significantly less frequent in those diagnosed immediately. 37% of those with stoma declined restoration of continuity. During restoration 3/47 had splenic injury. Postoperatively one had anastomotic leak, one had wound dehiscence, and two died. Conclusion: Endoscopic colonic injury requiring laparotomy is serious and associated with a high rate of complications. Swift recognition and treatment may reduce the complication rate. Both primary and secondary surgical procedures should be handled by specialists.

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