Enterocutaneous fistulas (ECFs) are abnormal connections between epithelium of the intestinal lumen and skin. The diagnosis and characterization of an ECF is vital to determine the appropriate treatment approach. Diagnosis of ECFs are typically made by visualization of succus drainage from a surgical incision. However, when diagnosis is unclear, various radiological modalities are available to aid diagnosis. We report a case of incidental application of nuclear medicine hepatobiliary iminodiacetic acid scan which led to the diagnosis of an ECF.

A 60-year-old female presented with symptoms consistent with a large bowel obstruction (LBO). Following confirmation of LBO using imaging, she progressed to a laparotomy which potentially revealed a large rectosigmoid tumor with surrounding adhesions, deemed unresectable. The postoperative course was complicated by an enterocutaneous fistula. She was transferred to a tertiary center and underwent a repeat laparotomy which revealed a large fibrotic mass associated with an intra-luminal bread clip (expiry date 2002). This case report details the interesting causative nature of this LBO and the subsequent surgical management, and complicated postoperative course.