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

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.