Combined Over-the-Scope-Clip and Detachable Snare Placement for Closure of an Enterocutaneous Fistula

Rui Morais, Eduardo Rodrigues-Pinto, Guilherme Macedo

Centro Hospitalar São João

A 75-year-old man underwent an extended right hemicolectomy due to an adenocarcinoma of the transverse colon. Forty-days later, patient presented with septic shock. Abdominal CT revealed a large intra-abdominal collection, which was percutaneously drained. One week later, an enterocutaneous fistula was identified. Instillation of methylene blue through the percutaneous drain revealed fistula location at the anastomosis. An OTSC was placed but methylene blue passage continued to occur. A detachable snare was placed at the base of the OTSC. Successful closure was achieved. Colonoscopy was repeated 3 months later, with the anastomosis being regular, without contrast extravasion. Patient remains well.