title: Enterocutaneous Fistula From A Billroth II Afferent Limb: Successful Closure With Endoclips.
abstract: Recently, indications for endoscopic clips have expanded to include closure of gastrointestinal fistulae and perforations. A 62-year-old man with remote history of surgery for peptic ulcer underwent right hemicolectomy for a large hepatic flexure mass with proximal colonic dilatation. During surgery, inadvertent pinpoint duodenotomy of the afferent Billroth II limb resulted in a duodeno-cutaneous fistula. Despite total parental nutrition, cutaneous bile drainage persisted. The duodenal fistula was closed during upper endoscopy using three endoclips. Cutaneous bile drainage stopped, and the abdominal wall defect healed. This is the first published case of endoclip closure of an iatrogenic duodenal fistula from a Billroth II afferent limb.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland Medical Center, Baltimore, MD ; Department of Gastroenterology, Baltimore VA Medical Center, Baltimore, MD.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Voellinger
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland Medical Center, Baltimore, MD ; Department of Gastroenterology, Baltimore VA Medical Center, Baltimore, MD.
authors.forename: Robert
authors.initials: R
authors.lastname: Knodell
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland Medical Center, Baltimore, MD ; Department of Gastroenterology, Baltimore VA Medical Center, Baltimore, MD.
authors.forename: Nabil
authors.initials: N
authors.lastname: Choueiri