Colonic perf during Cscope is generally from barotrauma due to overdistension of the colon with air, rather than the colonoscope poking through the wall (although the later can certainly occur). With barotrauma, you don’t just get a hole, you get the colon kind of splitting in longitudinal tears. For short segment you can oversew but frequently if the patient ends up in the OR, the damage is such that the entire area needs to be resected. Smaller tears which might otherwise be oversewn are frequently treated conservatively with bowel rest and antibiotics and don’t end up in the OR.