Endoscopic Closure of a Postoperative Duodenal Fistula

Introduction: Bouveret syndrome is a rare presentation of gallstone ileus characterized by passage of a gallstone through a cholecystoenteric fistula and impaction of the gallstone within the duodenum, causing proximal small bowel obstruction. Most patients require surgery with duodenotomy and stone extraction. Unfortunately, duodenal surgery has a high risk for surgical complications, including suture-line leaks and fistula formation. Fistulas that fail to close with conservative management, and those complicated by electrolyte and fluid disturbances, require surgical correction. Recently, overthe-scope clip devices have been used successfully for enteric fistula closure. Case Description: We present the case of a 33-year-old man with a postsurgical duodenal leak after duodenorrhaphy as surgical treatment for Bouveret syndrome. Two weeks after surgery, the patient underwent successful over-the-scope clip closure of a high-output duodenal fistula, requiring no subsequent endoscopic or operative fistula management. Discussion: Over-the-scope clips appear promising for successful closure of postsurgical duodenal fistulas that persist despite conservative management and optimized nutritional status.