LAUSR

Duodenal fistula is a rare but serious complication of gastrointestinal surgery, abdominal trauma, and iatrogenic procedures in general [1]. It is most commonly seen in critically ill patients at elevated risk of death, and its treatment is associated with great challenges, including repeated episodes of recurrence [2]. Endoscopic closure methods are now becoming more reliable and are already being considered as first-line options in the management of this condition. A 61-year-old man underwent ileocolectomy due to complicated appendicitis. He was referred to our institution and underwent a new procedure because of dehiscence of the ileocolic anastomosis. A new ileocolic anastomosis was performed. After a few days, the presence of a duodenal cutaneous fistula associated with a large peritoneal collection became evident. The peritoneal collection was surgically drained, but the duodenal leak persisted. The patient underwent an endoscopic closure attempt, performed with standard through-the-scope clips (TTSC). The procedure was unsuccessful, and the fistula showed signs of recanalization (▶Fig. 1). A second endoscopic procedure was performed, using the Amplatzer septal occluder (St. Jude Medical, St. Paul, Minnesota, USA). The Amplatzer is a self-expandable, double-disk occluder device developed for the endovascular treatment of persistent cardiac wall defects [3]. We fashioned an endoscopic introduction device using the external sheath of a 12-Fr biliary plastic stent and a pediatric biopsy forceps (▶Video 1; ▶Fig. 2). The opening of the first flange was performed under fluoroscopic guidance, while the second flange (in the duodenal lumen) was deployed under endoscopic surveillance (▶Fig. 3). ConE-Videos