Successful endoscopic treatment of hepatoduodenal fistula formed during sorafenib treatment for hepatocellular carcinoma with duodenal invasion

Hepatoduodenal fistula closure diagnosed and characterized Ecoendoscopically (EUS) and managed by OTSC CLIP OVESCO: A case report

Introduction

Gastrointestinal (GI) tract perforations are a significant source of morbidity in clinical practice; therefore, an early diagnosis is fundamental for early management. In management, surgery is the definitive therapy; however, there is evidence of a strong response to conservative measurements.

Presentation of case

A 53-year-old man known for a laparoscopic cholecystectomy with difficult access and postoperative complications was admitted to our emergency department due to a five-day clinical history comprising acute abdominal pain and feverish peaks up to 38.4 °C. Diagnosis methods CT and NMR were performed but did not lead to a clear diagnosis. Therefore, a EUS was performed observing an anechoic path that communicates the duodenal wall with a right subhepatic collection that was in contact with the proximal bile duct, thickening its walls. A 5 mm fistulous orifice was found. The hepatoduodenal fistula was close endoscopically with the over-the-scope-clip OVESCO OTSC. Post endoscopic closure course was uneventful.

Discussion

Duodenal fistulae are considered one of the most serious complications in gastrointestinal surgery, when conventional diagnosis methods do not permit the clinicians to get either a medical diagnosis or the management; the EUS can. Advances in interventional endoscopic techniques offer an alternative management for the closure of GI fistulae.

Conclusion

Whenever the presence of an organized fistula is clinically suspected, EUS can be considered a useful tool that allows not only the characterization of the fistulous path and but also the definition of the minimally invasive endoscopic treatment.

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Duodenal fistulae are considered one of the most serious complications in gastrointestinal surgery.

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Whenever the presence of an organized intestinal fistula is clinically suspected, EUS can be considered a useful tool that allows characterizing the fistulous path and defining the minimally invasive endoscopic treatment.