PMC4435281_01
(A and B) Large polypoid appearing mass at the hepatic flexure. (C) Fistula orifice originating from afferent Billroth II duodenal limb. (D) Three standard endoclips deployed with successful closure of fistula orifice.
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F1
On colonoscopy, there was an obstructing, near circumferential mass at the hepatic flexure (Figure 1A and Figure 1B) preventing further advancement of the colonoscope. Upper endoscopy was performed in anticipation of surgery to close the fistula, and the duodenal opening of the fistula was easily identified in the afferent limb of the Billroth II anastomosis (Figure 1C). Three standard endoclips were used to approximate the fistula opening (Figure 1D), resulting in immediate and lasting cessation of percutaneous bile drainage.