Transcutaneous closure of an enterocutaneous fistula using a cardiac septal occluder.

Background and Aims: Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and skin, often managed surgically with a recent shift toward endoscopic closure. We are presenting a case highlighting the off-label use of a septal occluder, placed transcutaneously under fluoroscopy, for the closure of an ECF. Methods: We are presenting a case of a 61-year-old woman with a history of metastatic colon cancer status post sigmoid resection with loop ileostomy and palliative chemotherapy. Her course was complicated by ECF with high-volume leakage. She was deemed not a surgical candidate and failed glue injections and surgical interventions. Results: Endoscopy including anterograde and retrograde single balloon enteroscopy failed to reach the fistula site. The patient underwent fluoroscopic ECF closure with off-label use of a septal occluder device. Conclusions: We report a successful off-label use of a septal occluder for the closure of a refractory ECF under fluoroscopic guidance with emphasis on the importance of a multidisciplinary approach and the exploration of innovative solutions in challenging clinical scenarios.