A critical case of postoperative duodenal fistula and retroperitoneal abscess after laparoscopic cholecystectomy: role of endoscopic fistula closure and multidisciplinary management

Postoperative duodenal fistula is a rare but serious complication after cholecystectomy and nephrectomy. A case of a 58-year-old woman with chronic calculous cholecystitis and right-sided nephrolithiasis who developed a postoperative duodenal fistula with retroperitoneal abscess is presented. Initial conservative management and percutaneous drainage were performed. Endoscopic closure using TTS endoclips and an endoloop was performed after five months of persistent fistula. Complete fistula closure was achieved, confirmed by follow-up endoscopy and CT scan. Endoscopic closure with TTS endoclips and an endoloop is an effective, minimally invasive option for small chronic duodenal fistulas. Over-the-scope clips (OTSCs) were not used due to the small fistula size and well-formed granulation tissue, which allowed for successful closure with conventional endoscopic tools.