# Endoscopic Creation of an Internal Enterocolonic Fistula for a Noncommunicating Bowel Loop: A Novel Minimally Invasive Approach

## TL;DR

A new minimally invasive endoscopic technique successfully treated a noncommunicating bowel segment in a high-risk patient.

## Contribution

A novel endoscopic approach using a metal stent to create an internal enterocolonic fistula in a complex surgical patient.

## Key findings

- Transrectal endoscopic ultrasound–guided enterocolostomy decompressed a noncommunicating bowel segment.
- Follow-up showed spontaneous maturation of the internal fistula with full symptom resolution.
- The technique offers a minimally invasive alternative to surgery in high-risk patients.

## Abstract

A 62-year-old woman with long-standing short bowel syndrome on chronic total parenteral nutrition and multiple abdominal surgeries presented with acute on chronic abdominal pain and sepsis. Imaging revealed a disconnected, dilated small bowel segment in the right lower quadrant, consistent with a so-called orphaned bowel loop. Given surgical risk, she underwent a transrectal endoscopic ultrasound–guided enterocolostomy with successful creation of a coloenteric anastomosis using a 20-mm lumen-apposing metal stent. The noncommunicating bowel decompressed completely, and she achieved full symptom resolution. Follow-up endoscopy demonstrated spontaneous maturation of an internal enterocolonic fistula. This case highlights a novel, minimally invasive approach for managing noncommunicating bowel in complex surgical patients.