Enteroscopy has a procedure-related perforation rate from less than 1% to 6.5%. It seems to be higher in therapeutic enteroscopy, especially polypectomy of large polyps, and in patients who have altered surgical anatomy. Early recognition is life-saving and studies have shown that if surgery is done within 12 hours of perforation the prognosis is better. In a patient who has undergone small bowel endoscopy the diagnosis of small bowel perforation should be suspected if the patient has acute pain in the abdomen. Early diagnosis should be the goal with prompt surgical correction.