title: Acute Cholangitis following Biliary Obstruction after Duodenal OTSC Placement in a Case of Large Chronic Duodenocutaneous Fistula.
abstract: Over-the-Scope Clip system, also called "Bear Claw," is a novel endoscopic modality used for closure of gastrointestinal defect with high efficacy and safety. We present a patient with history of eosinophilic gastroenteritis and multiple abdominal surgeries including Billroth II gastrectomy complicated by a large chronic duodenocutaneous fistula from a Billroth II afferent limb to the abdominal wall. Bear Claw clip was used for closure of this fistula. The patient developed acute cholangitis one day after placement of the Bear Claw clip. Acute cholangitis due to papillary obstruction is a potential complication of Bear Claw placement at the dome of the duodenal stump (afferent limb) in patient with Billroth II surgery due to its close proximity to the major papilla.
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Alastal
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Tariq A
authors.initials: TA
authors.lastname: Hammad
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Nawras
authors.affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Basmah W
authors.initials: BW
authors.lastname: Khalil
authors.affiliation: Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Alaradi
authors.affiliation: Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH 43614, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Nawras