Iatrogenic colon injury during a colonoscopy procedure is rare. The controversy exists when the surgical treatment of such lesions is concerned: operative or conservative. This case report is in favor of the operative endoscopic approach, with a literature review. An 80-year-old male sustained an iatrogenic endoscopic sigmoid colon perforation. Laparoscopic suturing was done within 5 hours after the perforation, with no complications after 4 months of follow-up.