Double balloon enteroscopy with laparoscopic assistance and surgical treatment of a subcutaneous varix fistula into the small bowel: case report and literature review

Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of gastro-intestinal (GI) bleedings and in most of the cases bleeding sources are reported within the small bowel. After video capsule endoscopy for diagnosis, enteroscopy is recommended to confirm and possibly treat lesions. Combined enteroscopic and laparoscopic approach to treat small bowel lesions has been described in literature. We report the case of a patient with a fistula formed from a subcutaneous varix infiltrating the small bowel with consequent bleeding and severe anemization. After several diagnostic tests, the patient underwent antegrade double-balloon enteroscopy under laparoscopic guidance and definitive surgical treatment.