AIM: Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy. CASE REPORT: A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1). After surgery, the patient underwent chemotherapy with folfirinox regimen. In December 2016, as a result of the appearance of metastatic liver lesions and perianastomotic recurrence, the patient underwent second line treatment with Gemcitabine and pab-paclitaxel. After five months from the beginning of this new second line therapy she presented an EC fistula. The fistula of the patient was successfully treated with total parenteral nutrition and with percutaneous injection of cyanoacrylic sealant. RESULTS: The result suggests the advisability of percutaneous injection of sealant devices, such as cyanoacrylate glue; in order to successfully control stable Enterocutaneous fistulas with acceptable morbidity and mortality especially in particular situations, such as, with low output EC fistulas without signs of complications or on patients considered not suitable for surgery, a conservative approach could ensure the control of the fistula. CONCLUSION: This approach is easy and safe, viable and useful for future trials on the efficacy in conservative treatment of EC fistula.
AIM: Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy. CASE REPORT: A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1). After surgery, the patient underwent chemotherapy with folfirinox regimen. In December 2016, as a result of the appearance of metastatic liver lesions and perianastomotic recurrence, the patient underwent second line treatment with Gemcitabine and pab-paclitaxel. After five months from the beginning of this new second line therapy she presented an EC fistula. The fistula of the patient was successfully treated with total parenteral nutrition and with percutaneous injection of cyanoacrylic sealant. RESULTS: The result suggests the advisability of percutaneous injection of sealant devices, such as cyanoacrylate glue; in order to successfully control stable Enterocutaneous fistulas with acceptable morbidity and mortality especially in particular situations, such as, with low output EC fistulas without signs of complications or on patients considered not suitable for surgery, a conservative approach could ensure the control of the fistula. CONCLUSION: This approach is easy and safe, viable and useful for future trials on the efficacy in conservative treatment of EC fistula.
Authors: Yasser M Bhat; Subhas Banerjee; Bradley A Barth; Shailendra S Chauhan; Klaus T Gottlieb; Vani Konda; John T Maple; Faris M Murad; Patrick R Pfau; Douglas K Pleskow; Uzma D Siddiqui; Jeffrey L Tokar; Amy Wang; Sarah A Rodriguez Journal: Gastrointest Endosc Date: 2013-08 Impact factor: 9.427
Authors: William P Schecter; Asher Hirshberg; David S Chang; Hobart W Harris; Lena M Napolitano; Steven D Wexner; Stanley J Dudrick Journal: J Am Coll Surg Date: 2009-07-02 Impact factor: 6.113
Authors: Giovanni Mauri; Lorenzo C Pescatori; Chiara Mattiuz; Dario Poretti; Vittorio Pedicini; Fabio Melchiorre; Umberto Rossi; Luigi Solbiati; Luca Maria Sconfienza Journal: Radiol Med Date: 2016-10-17 Impact factor: 3.469
Authors: Jose L Martinez; Enrique Luque-de-Leon; Juan Mier; Roberto Blanco-Benavides; Felipe Robledo Journal: World J Surg Date: 2008-03 Impact factor: 3.352
Authors: David H Ballard; Abigail E M Erickson; Chaitanya Ahuja; Romulo Vea; Guillermo P Sangster; Horacio B D'Agostino Journal: Dig Dis Interv Date: 2018-06-08