Magnetic functional undiversion in a patient with enteroatmospheric fistula and hostile abdomen: a case report

Enteroatmospheric fistula in the setting of a hostile abdomen represents a major surgical challenge. Conventional anastomotic techniques are often unfeasible due to friable tissue, extensive adhesions, and high operative risk. Magnetic compression anastomosis has emerged as a minimally invasive alternative for restoring intestinal continuity in complex surgical scenarios. We report the case of a 14-year-old male with total colonic aganglionosis diagnosed in early childhood and initially managed with a diverting colostomy. Definitive reconstruction was delayed due to loss of follow-up after relocation to a remote region with limited access to specialized pediatric surgical care. At 14 years of age, the patient underwent intestinal reconstruction, which was complicated by an anastomotic leak, multiple laparotomies, and the development of a single enteroatmospheric fistula in the setting of a persistent hostile abdomen. Given the high surgical risk, the patient was not considered a candidate for conventional reoperation. A custom-made magnetic compression device was therefore designed to adapt to the patient’s altered intestinal anatomy and the absence of commercially available magnetic systems for pediatric functional undiversion in the region. The device consisted of two annular neodymium magnets coated with methyl methacrylate, one housed within a convex 3D-printed thermoplastic polyurethane cover, and was placed endoluminally under endoscopic guidance. Also radiographic flow up was made. The magnets achieved proper alignment and were spontaneously expelled on postoperative day 7. By postoperative day 14, intestinal transit was restored and enteral feeding was resumed without evidence of leak or infection, achieving functional closure of the fistula. Due to severe loss of abdominal wall domain, abdominal wall closure was managed by secondary intention. Magnetic compression anastomosis seems to be a safe and effective alternative for the management of single enteroatmospheric fistulas.