A 40 year-old woman with acute pancreatitis requiring several abdominal surgeries
presented with an ileo-cutaneous fistula.
A pediatric gastroscope was inserted through the fistula to the afferent loop (AL).
An echoendoscope was inserted through the ileostomy identifying the AL. EUS-guided
entero-enterostomy with a lumen-apposing-metallic-stent (LAMS) failed due to loop
stiffness with migration of the LAMS to the peritoneal cavity. The LAMS was removed
with an endoscope and a rescue entero-enterostomy with a SEMS from the ileal to the
AL was performed to bypass and close the fistula.
Entero-enterostomies with SEMS must preserve the bowel transit to avoid secondary
bowel occlusion.
